Provider Demographics
NPI:1649468653
Name:ROBERT M. DEBELLEVUE, MD A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:ROBERT M. DEBELLEVUE, MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEBELLEVUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-469-3434
Mailing Address - Street 1:200 W ESPLANADE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2473
Mailing Address - Country:US
Mailing Address - Phone:504-469-3434
Mailing Address - Fax:504-469-1172
Practice Address - Street 1:200 W ESPLANADE AVE STE 310
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2474
Practice Address - Country:US
Practice Address - Phone:504-469-3434
Practice Address - Fax:504-469-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CB73Medicare PIN