MEDICARE: RAUL ERNESTO LOAISIGA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	L0383	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235132796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAUL ERNESTO LOAISIGA M.D.

Provider Business Mailing Address
First Line	:	4770 NORTH EXPRESSWAY 77/83 SUITE 206
Second Line	:
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-4780
Country	:	US
Telephone Number	:	956-350-5500
Fax Number	:	956-350-4965

Provider Business Practice Location Address
First Line	:	4770 N EXPRESSWAY # 7783
Second Line	:	STE 206
City	:	BROWNSVILLE
State	:	TX
Zip	:	78526-4120
Country	:	US
Telephone Number	:	956-350-5500
Fax Number	:	956-350-4965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	09/28/2015

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