Healthcare Provider Details

I. General information

NPI: 1134190465
Provider Name (Legal Business Name): RALPH W COLPITTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 10/25/2022
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 W PRIEN LAKE RD
LAKE CHARLES LA
70601-8450
US

IV. Provider business mailing address

215 W PRIEN LAKE RD
LAKE CHARLES LA
70601-8450
US

V. Phone/Fax

Practice location:
  • Phone: 337-502-8706
  • Fax: 377-210-1271
Mailing address:
  • Phone: 337-502-8706
  • Fax: 377-210-1271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number05703R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: