Provider Demographics
NPI:1962623215
Name:CADOGAN, ROBERT VICTOR (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VICTOR
Last Name:CADOGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 MEADOW LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5552
Mailing Address - Country:US
Mailing Address - Phone:504-821-6287
Mailing Address - Fax:
Practice Address - Street 1:3160 MEADOW LAKE DR E
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5552
Practice Address - Country:US
Practice Address - Phone:504-821-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD119R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1920461Medicaid
LA5S593Medicare PIN
LAU19370Medicare UPIN