Provider Demographics
NPI:1861536963
Name:MOUNAYAR, ELIAS RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:ELIAS
Middle Name:RAYMOND
Last Name:MOUNAYAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 MOREAU ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-2956
Mailing Address - Country:US
Mailing Address - Phone:318-253-5600
Mailing Address - Fax:318-253-5602
Practice Address - Street 1:338 MOREAU ST
Practice Address - Street 2:SUITE D
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2956
Practice Address - Country:US
Practice Address - Phone:318-253-5600
Practice Address - Fax:318-253-5602
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15834R207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1471771Medicaid
LA1471771Medicaid
LAI40478Medicare UPIN