Basic Information
| Provider Information | |||||||||
| NPI: | 1861460453 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOBER | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 DR MICHAEL DEBAKEY DR | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706015724 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3373128258 | ||||||||
| FaxNumber: | 3373126711 | ||||||||
| Practice Location | |||||||||
| Address1: | 641 DR MICHAEL DEBAKEY DR | ||||||||
| Address2: | |||||||||
| City: | LAKE CHARLES | ||||||||
| State: | LA | ||||||||
| PostalCode: | 706015726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3374334651 | ||||||||
| FaxNumber: | 3374391702 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 01/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 013236 | LA | N | Other Service Providers | Specialist | 208G00000X | 013236 | LA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 1700823 | 01 | LA | UNITED HEALTH ID | OTHER | 1942352 | 01 | LA | FIRST HEALTH ID# | OTHER | 1319902 | 05 | LA | MEDICAID | 721164556 | 01 | LA | TAX ID# | OTHER | 020002008 | 01 | LA | RAILROAD MEDICARE ID | OTHER |