Provider Demographics
NPI:1285969410
Name:P. TRUETT RAY, JR.,M.D.L.L.C.
Entity type:Organization
Organization Name:P. TRUETT RAY, JR.,M.D.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:P.
Authorized Official - Middle Name:TRUETT
Authorized Official - Last Name:RAY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:985-448-3055
Mailing Address - Street 1:504 N ACADIA RD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4862
Mailing Address - Country:US
Mailing Address - Phone:985-447-5667
Mailing Address - Fax:985-447-5670
Practice Address - Street 1:504 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4862
Practice Address - Country:US
Practice Address - Phone:985-447-5667
Practice Address - Fax:985-447-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD013941208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
P0065497OtherRAILROAD MEDICARE
LA1333948Medicaid
LA54902Medicare PIN
P0065497OtherRAILROAD MEDICARE