Healthcare Provider Details

I. General information

NPI: 1952607343
Provider Name (Legal Business Name): ROBERT LOUIS AUTIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2011
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W PINHOOK RD SUITE 310
LAFAYETTE LA
70503-2460
US

IV. Provider business mailing address

1000 W PINHOOK RD SUITE 310
LAFAYETTE LA
70503-2460
US

V. Phone/Fax

Practice location:
  • Phone: 337-233-9900
  • Fax: 337-233-0770
Mailing address:
  • Phone: 337-233-9900
  • Fax: 337-233-0770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number207630
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: