Healthcare Provider Details

I. General information

NPI: 1619027232
Provider Name (Legal Business Name): CARL J RICHARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 JACKSON AVE
KAPLAN LA
70548-3920
US

IV. Provider business mailing address

1305 CROWLEY RAYNE HWY
CROWLEY LA
70526-8202
US

V. Phone/Fax

Practice location:
  • Phone: 337-643-8583
  • Fax: 337-673-2874
Mailing address:
  • Phone: 337-788-6407
  • Fax: 337-788-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number012524
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: