Basic Information
| Provider Information | |||||||||
| NPI: | 1164612677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBERTS | ||||||||
| FirstName: | CLAIRE | ||||||||
| MiddleName: | KNOBLES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8230 SUMMA AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257570552 | ||||||||
| FaxNumber: | 2257639997 | ||||||||
| Practice Location | |||||||||
| Address1: | 8230 SUMMA AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257570552 | ||||||||
| FaxNumber: | 2257639997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2007 | ||||||||
| LastUpdateDate: | 05/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD.201629 | LA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 06052010 | 05 | MS | MEDICAID | 1077461 | 05 | LA | MEDICAID |