Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | NONE | LA |
Y | 222Z00000X | Podiatrist | NONE | LA |
N | 225000000X | Orthotic Fitter |
NPI | 1871744714 |
---|---|
Provider Name | Mr. Blake Anthony Robichaux |
First Address | New Orleans, LA 70112-1262 |
Second Address | New Orleans, LA 70112-1262 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2008 |
Last Update Date | 09/10/2008 |