Provider Demographics
NPI:1285794693
Name:MOUKARZEL, ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MOUKARZEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 SAINT CLAIR BLVD
Mailing Address - Street 2:STE 1020
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5023
Mailing Address - Country:US
Mailing Address - Phone:225-743-2000
Mailing Address - Fax:225-743-2010
Practice Address - Street 1:1014 SAINT CLAIR BLVD
Practice Address - Street 2:STE 1020
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5023
Practice Address - Country:US
Practice Address - Phone:225-743-2000
Practice Address - Fax:225-743-2010
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2017-09-20
Deactivation Date:2017-09-18
Deactivation Code:
Reactivation Date:2017-09-20
Provider Licenses
StateLicense IDTaxonomies
LA13495R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F42392Medicare UPIN
LA5H175Medicare ID - Type Unspecified
LA1440396Medicaid
LA5H175DG73OtherMEDICARE PTAN