Individual
RICHARD C VANDERBROOK JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1202 S TYLER ST, COVINGTON, LA 70433-2330
(985) 898-4000
Mailing address
621 HICKORY AVE, HARAHAN, LA 70123-3106
(504) 738-2434
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
12282R
LA
2085R0202X
Diagnostic Radiology Physician
MD12282R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04407801
—
MS
05
—
1698971
—
LA
Enumeration date
05/22/2006
Last updated
05/18/2021
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