1285690719 NPI number — JULIET ROBINSON CONDE M.D.

Table of content: JULIET ROBINSON CONDE M.D. (NPI 1285690719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285690719 NPI number — JULIET ROBINSON CONDE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONDE
Provider First Name:
JULIET
Provider Middle Name:
ROBINSON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBINSON
Provider Other First Name:
JULIET
Provider Other Middle Name:
ARNELL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1285690719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 DUPLECHIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHURCH POINT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70525-6832
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-543-4452
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3521 HIGHWAY 190
Provider Second Line Business Practice Location Address:
SUITE V
Provider Business Practice Location Address City Name:
EUNICE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70535-5135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-550-0405
Provider Business Practice Location Address Fax Number:
337-550-0409
Provider Enumeration Date:
04/24/2006

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: 207P00000X , with the licence number:  MD.022508 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 022508 , 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: 1497738 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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