Healthcare Provider Details

I. General information

NPI: 1194773069
Provider Name (Legal Business Name): ADAM IRWIN RIKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 TULANE AVE ROOM 741
NEW ORLEANS LA
70112-2865
US

IV. Provider business mailing address

1542 TULANE AVE ROOM 741
NEW ORLEANS LA
70112-2865
US

V. Phone/Fax

Practice location:
  • Phone: 504-568-4752
  • Fax: 504-568-2726
Mailing address:
  • Phone: 504-568-4752
  • Fax: 504-568-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD.202666
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: