Provider Demographics
NPI:1649783465
Name:RICHARD, BOBBY JOHN JR (MS)
Entity type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:JOHN
Last Name:RICHARD
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 E SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-3752
Mailing Address - Country:US
Mailing Address - Phone:373-321-9204
Mailing Address - Fax:337-321-9210
Practice Address - Street 1:449 E SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3752
Practice Address - Country:US
Practice Address - Phone:373-321-9204
Practice Address - Fax:337-321-9210
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator