Provider Demographics
NPI: | 1386616571 |
---|---|
Name: | FEBRY, RICARDO (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | RICARDO |
Middle Name: | |
Last Name: | FEBRY |
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: | 3941 HOUMA BLVD STE 1A |
Mailing Address - Street 2: | |
Mailing Address - City: | METAIRIE |
Mailing Address - State: | LA |
Mailing Address - Zip Code: | 70006-2920 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 504-457-2200 |
Mailing Address - Fax: | 504-457-2207 |
Practice Address - Street 1: | 3941 HOUMA BLVD STE 1A |
Practice Address - Street 2: | |
Practice Address - City: | METAIRIE |
Practice Address - State: | LA |
Practice Address - Zip Code: | 70006-2920 |
Practice Address - Country: | US |
Practice Address - Phone: | 504-457-2200 |
Practice Address - Fax: | 504-457-2207 |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-02-02 |
Last Update Date: | 2023-07-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
LA | 09228R | 207R00000X |
LA | MD.09228R | 207RH0002X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RH0002X | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
LA | 1962899 | Medicaid | |
LA | 1962899 | Medicaid | |
LA | 5R605 | Medicare PIN |