Healthcare Provider Details

I. General information

NPI: 1386777597
Provider Name (Legal Business Name): SIDNEY H RAYMOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4315 HOUMA BLVD STE 204
METAIRIE LA
70006-2940
US

IV. Provider business mailing address

4315 HOUMA BLVD STE 204
METAIRIE LA
70006-2940
US

V. Phone/Fax

Practice location:
  • Phone: 504-889-5250
  • Fax: 504-889-5288
Mailing address:
  • Phone: 504-889-5250
  • Fax: 504-889-5288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number023838
License Number StateLA

VIII. Authorized Official

Name: DR. SIDNEY H RAYMOND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 504-889-5250