Provider Demographics
NPI:1437175221
Name:SMITH, ROBERT EDMOND (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDMOND
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 2668
Mailing Address - Street 2:RADIOLOGY DEPARTMENT
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-2668
Mailing Address - Country:US
Mailing Address - Phone:985-230-6700
Mailing Address - Fax:985-230-1528
Practice Address - Street 1:15790 PAUL VEGA MD DR
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1434
Practice Address - Country:US
Practice Address - Phone:985-230-6700
Practice Address - Fax:985-230-1528
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2019-09-10
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Provider Licenses
StateLicense IDTaxonomies
LAMD.08899R2085R0202X
LA08899R2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1376752Medicaid
LA1376752Medicaid
LA1376752Medicaid