Healthcare Provider Details

I. General information

NPI: 1588875017
Provider Name (Legal Business Name): TREVOR C. RICHARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 S SAINT ELIZABETH BLVD
GONZALES LA
70737-5021
US

IV. Provider business mailing address

2647 S SAINT ELIZABETH BLVD
GONZALES LA
70737-5021
US

V. Phone/Fax

Practice location:
  • Phone: 225-647-8511
  • Fax: 225-644-5213
Mailing address:
  • Phone: 225-647-8511
  • Fax: 225-644-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number202291
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number202291
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: