Provider Demographics
NPI:1730264920
Name:MCCORD, ROBERT WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:MCCORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4300 HOUMA BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2924
Mailing Address - Country:US
Mailing Address - Phone:504-503-6791
Mailing Address - Fax:504-503-6710
Practice Address - Street 1:9605 JEFFERSON HWY
Practice Address - Street 2:SUITE F
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-2550
Practice Address - Country:US
Practice Address - Phone:504-738-1600
Practice Address - Fax:504-737-1264
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.016105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1945285Medicaid
LA1339687Medicaid
LA721472390OtherTIN COMMERCIAL CARRIERS
LA1945285Medicaid
LA5L722Medicare ID - Type Unspecified
LA1339687Medicaid