Provider Demographics
NPI:1104086271
Name:DAUGHERTY, ROBYN DERANGER (MD)
Entity type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:DERANGER
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBYN
Other - Middle Name:LEE
Other - Last Name:DERANGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1542 TULANE AVENUE ROOM 734 A
Mailing Address - Street 2:LSUHSC DEPARTMENT OF SURGERY
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112
Mailing Address - Country:US
Mailing Address - Phone:504-568-4760
Mailing Address - Fax:504-568-4633
Practice Address - Street 1:4212 BLUEBONNET BLVD STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-9675
Practice Address - Country:US
Practice Address - Phone:225-399-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203151208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery