Healthcare Provider Details

I. General information

NPI: 1487757043
Provider Name (Legal Business Name): RANDOLPH L ROIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CANAL ST
NEW ORLEANS LA
70119-6535
US

IV. Provider business mailing address

1633 ROBERT ST
NEW ORLEANS LA
70115-4925
US

V. Phone/Fax

Practice location:
  • Phone: 504-507-7693
  • Fax:
Mailing address:
  • Phone: 504-897-4852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number09912R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number09912R
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number09912R
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number09912R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: