Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 6663 | LA |
Y | 213EG0000X | General Practice | 6663 | LA |
NPI | 1003265448 |
---|---|
Provider Name | Jacob Robichaux |
First Address | Alexandria, LA 71301-3600 |
Second Address | Alexandria, LA 71301-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 07/06/2016 |