Healthcare Provider Details

I. General information

NPI: 1871744714
Provider Name (Legal Business Name): BLAKE ANTHONY ROBICHAUX CO,BOCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 PERDIDO ST
NEW ORLEANS LA
70112-1262
US

IV. Provider business mailing address

1601 PERDIDO ST P.O. BOX 61011
NEW ORLEANS LA
70112-1262
US

V. Phone/Fax

Practice location:
  • Phone: 504-553-5835
  • Fax: 504-553-5832
Mailing address:
  • Phone: 504-553-5835
  • Fax: 504-553-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberNONE
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: