Provider Demographics
NPI:1306934880
Name:STROBACH, RICHARD PETER (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:PETER
Last Name:STROBACH
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:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-0246
Mailing Address - Country:US
Mailing Address - Phone:985-542-0052
Mailing Address - Fax:985-542-4928
Practice Address - Street 1:15752 PROFESSIONAL PLAZA STREET
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403
Practice Address - Country:US
Practice Address - Phone:985-542-0052
Practice Address - Fax:985-542-4928
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0128742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA17367990OtherTRICARE
LA1143685Medicaid
LAB65701Medicare UPIN
LA55287Medicare ID - Type Unspecified