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General NPI Number Information
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NPI Number | 1639268196
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Entity Type | Individual
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Provider Name | RICHARD GERARD PALECKI D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 08/22/2011
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Provider Practice Location Address
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Address Line | 230 ROBERTS DR SUITE G
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City | NEW ROADS
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State | LA
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Zip | 70760-2661
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Country | US
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Telephone | 225-638-6640
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Fax | 225-618-0863
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Provider Business Mailing Address
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Address Line | PO BOX 575
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City | LIVONIA
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State | LA
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Zip | 70755-0575
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Country | US
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Telephone | 225-718-5314
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Fax | 225-618-0863
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | PD165R
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License Number State | LA
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