Basic Information
| Provider Information | |||||||||
| NPI: | 1699024901 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DR ROBERT ADAM BROCATO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2673 | ||||||||
| Address2: | |||||||||
| City: | NATCHITOCHES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714572673 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006840052 | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 HIGHLAND DRIVE | ||||||||
| Address2: | |||||||||
| City: | MANY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 714493718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3182565691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2012 | ||||||||
| LastUpdateDate: | 10/16/2012 | ||||||||
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| AuthorizedOfficialLastName: | BROCATO | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | ADAM | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3182565691 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | LA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1052400 | 05 | LA | MEDICAID |