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General NPI Number Information
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NPI Number | 1053865360
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Entity Type | Organization
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Legal Business Name | ROBIN DALE M.D. LLC
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 8369 FLORIDA BLVD STE 5
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-7862
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Country | US
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Telephone | 225-270-8783
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Fax |
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Provider Business Mailing Address
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Address Line | 8369 FLORIDA BLVD STE 5
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City | DENHAM SPRINGS
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State | LA
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Zip | 70726-7862
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Country | US
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Telephone | 225-270-8783
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | ROBIN BARRY DALE
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Credential | MD
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Telephone | 225-270-8783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 025676
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License Number State | LA
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