Provider Demographics
NPI:1386762052
Name:EDWARD E.GRAUL,JR, MD, APMC
Entity type:Organization
Organization Name:EDWARD E.GRAUL,JR, MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GRAUL
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-457-1638
Mailing Address - Street 1:251 MOOSA BLVD
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-3638
Mailing Address - Country:US
Mailing Address - Phone:337-457-1638
Mailing Address - Fax:337-457-1656
Practice Address - Street 1:251 MOOSA BLVD
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-3638
Practice Address - Country:US
Practice Address - Phone:337-457-1638
Practice Address - Fax:337-457-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14875207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1198587Medicaid
LAB89516Medicare UPIN
LA52258Medicare PIN
LA0316730001Medicare NSC