Provider Demographics
NPI:1497965198
Name:ROBLEDO, RAFAEL O (MD)
Entity type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:O
Last Name:ROBLEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1799
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-1799
Mailing Address - Country:US
Mailing Address - Phone:985-542-6251
Mailing Address - Fax:985-345-2386
Practice Address - Street 1:42388 PELICAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2412
Practice Address - Country:US
Practice Address - Phone:985-542-6251
Practice Address - Fax:985-345-2386
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA203282207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1942389986OtherGROUP NPI #
LA1507636Medicaid
LA4P9370055Medicare UPIN