MEDICARE: DR. RAYMOND J. STEINER D.D.S.

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	1223P0300X	Periodontics	4011	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	827810	OTHER	LA	UNITED CONCORDIA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	G1234	OTHER	LA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1457341687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND J. STEINER D.D.S.

Provider Business Mailing Address
First Line	:	4108 WOODSIDE DR
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-4034
Country	:	US
Telephone Number	:	337-478-4784
Fax Number	:

Provider Business Practice Location Address
First Line	:	4550 LAKE ST
Second Line	:
City	:	LAKE CHARLES
State	:	LA
Zip	:	70605-5414
Country	:	US
Telephone Number	:	337-478-1000
Fax Number	:	337-478-7200

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

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	07/08/2007

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