Basic Information
| Provider Information | |||||||||
| NPI: | 1255475471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATTY | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11408 LAKE SHERWOOD AVE N STE A | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708160421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257549478 | ||||||||
| FaxNumber: | 2256598033 | ||||||||
| Practice Location | |||||||||
| Address1: | 11408 LAKE SHERWOOD AVE N STE A | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708160421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257549478 | ||||||||
| FaxNumber: | 2256598033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2007 | ||||||||
| LastUpdateDate: | 03/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 11365R | LA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 11365R | 01 | LA | LA STATE MED LIC | OTHER | 1662712 | 05 | LA | MEDICAID |