1518943398 NPI number — DR. ROBERT KEEN FELL M.D.

Table of content: DR. ROBERT KEEN FELL M.D. (NPI 1518943398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518943398 NPI number — DR. ROBERT KEEN FELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELL
Provider First Name:
ROBERT
Provider Middle Name:
KEEN
Provider Name Prefix Text:
DR.
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:
FELL
Provider Other First Name:
ROBERT
Provider Other Middle Name:
KEEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1518943398
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4540 AMBASSADOR CAFFERY PKWY
Provider Second Line Business Mailing Address:
A110
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70508
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-984-1610
Provider Business Mailing Address Fax Number:
337-984-2136

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4540 AMBASSADOR CAFFERY PKWY
Provider Second Line Business Practice Location Address:
A110
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70508-6928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-984-1610
Provider Business Practice Location Address Fax Number:
337-984-2136
Provider Enumeration Date:
12/22/2005

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:  02923R , 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: 1136450 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com