Healthcare Provider Details

I. General information

NPI: 1982916516
Provider Name (Legal Business Name): RICHARD ROBERT VATH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 HENNESSY BLVD MEDICAL STAFF OFFICE
BATON ROUGE LA
70808-4375
US

IV. Provider business mailing address

5000 HENNESSY BLVD MEDICAL STAFF OFFICE
BATON ROUGE LA
70808-4375
US

V. Phone/Fax

Practice location:
  • Phone: 225-765-8306
  • Fax: 225-765-8546
Mailing address:
  • Phone: 225-765-8306
  • Fax: 225-765-8546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number014219
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: