Healthcare Provider Details

I. General information

NPI: 1609876226
Provider Name (Legal Business Name): ROBERT J OERTLING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59125 N PEARL DR
SLIDELL LA
70461-3727
US

IV. Provider business mailing address

59125 N PEARL DR
SLIDELL LA
70461-3727
US

V. Phone/Fax

Practice location:
  • Phone: 985-643-7927
  • Fax: 985-641-0209
Mailing address:
  • Phone: 985-643-7927
  • Fax: 985-641-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10671R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: