Healthcare Provider Details

I. General information

NPI: 1639559255
Provider Name (Legal Business Name): TAYLOR AUGUST ROBERTSON D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 GENTILLY BLVD
NEW ORLEANS LA
70122-3854
US

IV. Provider business mailing address

3100 GENTILLY BLVD
NEW ORLEANS LA
70122-3854
US

V. Phone/Fax

Practice location:
  • Phone: 504-323-5251
  • Fax: 504-383-0594
Mailing address:
  • Phone: 504-323-5251
  • Fax: 504-383-0594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberDPM.200075
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: