Healthcare Provider Details

I. General information

NPI: 1952457244
Provider Name (Legal Business Name): RICHARD H TIMPTON III LRT(R)
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 GENERAL MEYER AVE UPPER
NEW ORLEANS LA
70114-3048
US

IV. Provider business mailing address

2701 GENERAL MEYER AVE UPPER
NEW ORLEANS LA
70114-3048
US

V. Phone/Fax

Practice location:
  • Phone: 504-240-7066
  • Fax: 504-367-3645
Mailing address:
  • Phone: 504-240-7066
  • Fax: 504-367-3645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3402X
TaxonomyRadiography Radiologic Technologist
License Number2530
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: