Healthcare Provider Details

I. General information

NPI: 1558334839
Provider Name (Legal Business Name): ROBERT LADD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 LOCUST ST
LA CROSSE KS
67548-9673
US

IV. Provider business mailing address

801 LOCUST ST
LA CROSSE KS
67548-9673
US

V. Phone/Fax

Practice location:
  • Phone: 785-222-2545
  • Fax: 785-222-2868
Mailing address:
  • Phone: 785-222-2545
  • Fax: 785-222-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number76485
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: