Healthcare Provider Details

I. General information

NPI: 1285817585
Provider Name (Legal Business Name): GENERAL VASCULAR THORACIC SURGERY,L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

641 S. RYAN
LAKE CHARLES LA
70601
US

IV. Provider business mailing address

641 S RYAN ST
LAKE CHARLES LA
70601-5726
US

V. Phone/Fax

Practice location:
  • Phone: 337-433-4651
  • Fax:
Mailing address:
  • Phone: 337-433-4651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number013236
License Number StateLA

VIII. Authorized Official

Name: DR. RONALD S KOBER
Title or Position: OWNER
Credential: M.D.
Phone: 337-433-4651