Provider Demographics
NPI:1194996637
Name:AKIN, RICHARD TIPERY (MD, DDS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:TIPERY
Last Name:AKIN
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 CONNELLS PARK LN
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-6534
Mailing Address - Country:US
Mailing Address - Phone:225-927-3463
Mailing Address - Fax:225-927-8507
Practice Address - Street 1:614 CONNELLS PARK LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-6534
Practice Address - Country:US
Practice Address - Phone:225-927-3463
Practice Address - Fax:225-927-8507
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALA5084204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1850845Medicaid
LA$$$$$$$$$0OtherBCBS ID
LA1850845Medicaid