Healthcare Provider Details

I. General information

NPI: 1295995405
Provider Name (Legal Business Name): JEFFREY FREDERICK RAU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5619 HIGHWAY 311 STE C
HOUMA LA
70360-5595
US

IV. Provider business mailing address

5619 HIGHWAY 311 STE C
HOUMA LA
70360-5595
US

V. Phone/Fax

Practice location:
  • Phone: 985-709-0467
  • Fax: 877-218-5120
Mailing address:
  • Phone: 985-709-0467
  • Fax: 877-218-5120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number204776
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number204776
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: