Provider Demographics
NPI:1770537243
Name:DIAZ, RAUL R (MD)
Entity type:Individual
Prefix:DR
First Name:RAUL
Middle Name:R
Last Name:DIAZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4515 SHORES DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-6808
Mailing Address - Country:US
Mailing Address - Phone:504-309-2362
Mailing Address - Fax:504-872-9744
Practice Address - Street 1:4515 SHORES DR
Practice Address - Street 2:SUITE 102
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-6808
Practice Address - Country:US
Practice Address - Phone:504-309-2362
Practice Address - Fax:504-872-9744
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2011-04-15
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Provider Licenses
StateLicense IDTaxonomies
LA16182207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1138355Medicaid
LA1138355Medicaid
LAB62962Medicare UPIN