Provider Demographics
NPI:1174083620
Name:ROBICHAUX, CAROLINE CAMILLE (MD)
Entity type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:CAMILLE
Last Name:ROBICHAUX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 GRAND LAKES DR
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-1610
Mailing Address - Country:US
Mailing Address - Phone:985-414-5484
Mailing Address - Fax:
Practice Address - Street 1:1238 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2745
Practice Address - Country:US
Practice Address - Phone:985-872-5267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA333165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program