Provider Demographics
NPI:1093196503
Name:ROBERTSON FOOT AND ANKLE
Entity type:Organization
Organization Name:ROBERTSON FOOT AND ANKLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:318-458-1942
Mailing Address - Street 1:1477 LOUISIANA AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-3540
Mailing Address - Country:US
Mailing Address - Phone:504-323-5251
Mailing Address - Fax:
Practice Address - Street 1:1477 LOUISIANA AVE
Practice Address - Street 2:STE 101
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3540
Practice Address - Country:US
Practice Address - Phone:504-323-5251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADPM.200075261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA7463040001Medicare NSC