Provider Demographics
NPI:1801922414
Name:HAMSA, RUDOLF VACLAV (MD)
Entity type:Individual
Prefix:DR
First Name:RUDOLF
Middle Name:VACLAV
Last Name:HAMSA
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 1:4204 TEUTON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4164
Mailing Address - Country:US
Mailing Address - Phone:504-455-6310
Mailing Address - Fax:504-455-6312
Practice Address - Street 1:4204 TEUTON ST FL 2
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4164
Practice Address - Country:US
Practice Address - Phone:504-455-6310
Practice Address - Fax:504-455-6312
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA02734R207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1139831Medicaid
LA52495Medicare ID - Type Unspecified
LA1139831Medicaid