Provider Demographics
NPI:1881731222
Name:GRIESHABER, ROBERT J (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:GRIESHABER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-2422
Mailing Address - Country:US
Mailing Address - Phone:985-893-1035
Mailing Address - Fax:985-893-1058
Practice Address - Street 1:714 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-2422
Practice Address - Country:US
Practice Address - Phone:985-893-1035
Practice Address - Fax:985-893-1058
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014156207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA014156OtherLA MEDICAL LISC
52347Medicare ID - Type Unspecified
LA014156OtherLA MEDICAL LISC