Basic Information
| Provider Information | |||||||||
| NPI: | 1992770333 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROPPOLO | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | KYLE | ||||||||
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| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11271 FLORIDA BLVD. | ||||||||
| Address2: | APT. 213 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708152061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2252786766 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7777 HENNESSY BLVD. | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708084300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257657163 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2006 | ||||||||
| LastUpdateDate: | 02/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA.200049 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 1581721 | 05 | LA | MEDICAID |