Healthcare Provider Details

I. General information

NPI: 1700825346
Provider Name (Legal Business Name): HERBERT ROBINSON III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15813 PAUL VEGA MD DR STE 200
HAMMOND LA
70403-1431
US

IV. Provider business mailing address

PO BOX 3087 CREDENTIALING
HAMMOND LA
70404-3087
US

V. Phone/Fax

Practice location:
  • Phone: 985-230-7440
  • Fax: 985-230-7441
Mailing address:
  • Phone: 985-230-1682
  • Fax: 985-230-6652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13731R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: