Basic Information
| Provider Information | |||||||||
| NPI: | 1922075803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROVIRA | ||||||||
| FirstName: | KLAR | ||||||||
| MiddleName: | ANTONIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | IV | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2710 | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704592710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856460691 | ||||||||
| FaxNumber: | 9856460750 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 GAUSE BLVD | ||||||||
| Address2: | |||||||||
| City: | SLIDELL | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704582939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9856460691 | ||||||||
| FaxNumber: | 9856460750 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 2085R0202X | 10064R | LA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00119940 | 05 | MS | MEDICAID | 1497797 | 05 | LA | MEDICAID |