Provider Demographics
NPI:1730186750
Name:ROY, ALPHONSE KENISON III (MD)
Entity type:Individual
Prefix:DR
First Name:ALPHONSE
Middle Name:KENISON
Last Name:ROY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:A.
Other - Middle Name:KENISON
Other - Last Name:ROY
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4824 CLEARY AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-1316
Mailing Address - Country:US
Mailing Address - Phone:504-453-7598
Mailing Address - Fax:
Practice Address - Street 1:4824 CLEARY AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-1316
Practice Address - Country:US
Practice Address - Phone:504-453-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA120782084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1324400Medicaid
LAB89887Medicare UPIN
LA1324400Medicaid