MEDICARE: ROBERT M DEBELLEVUE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	3109	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245222595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT M DEBELLEVUE MD

Provider Business Mailing Address
First Line	:	200 W ESPLANADE AVE
Second Line	:	STE 104
City	:	KENNER
State	:	LA
Zip	:	70065-2489
Country	:	US
Telephone Number	:	504-469-3434
Fax Number	:	504-469-1172

Provider Business Practice Location Address
First Line	:	200 W ESPLANADE AVE STE 310
Second Line	:
City	:	KENNER
State	:	LA
Zip	:	70065-2474
Country	:	US
Telephone Number	:	504-469-3434
Fax Number	:	504-469-1172

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	02/24/2021

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