1861460453 NPI number — RONALD S KOBER M.D.

Table of content: RONALD S KOBER M.D. (NPI 1861460453)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861460453 NPI number — RONALD S KOBER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOBER
Provider First Name:
RONALD
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861460453
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 DR MICHAEL DEBAKEY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE CHARLES
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70601-5724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-312-8258
Provider Business Mailing Address Fax Number:
337-312-6711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
641 DR MICHAEL DEBAKEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70601-5726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-433-4651
Provider Business Practice Location Address Fax Number:
337-439-1702
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  013236 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208G00000X , with the licence number: 013236 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1700823 . This is a "UNITED HEALTH ID" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1942352 . This is a "FIRST HEALTH ID#" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1319902 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 721164556 . This is a "TAX ID#" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 020002008 . This is a "RAILROAD MEDICARE ID" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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