Provider Demographics
NPI:1962429985
Name:ERATO, THADDEUS RAY (MD)
Entity type:Individual
Prefix:
First Name:THADDEUS
Middle Name:RAY
Last Name:ERATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4678
Mailing Address - Country:US
Mailing Address - Phone:504-339-3472
Mailing Address - Fax:
Practice Address - Street 1:1052 LAKESHORE BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4678
Practice Address - Country:US
Practice Address - Phone:504-339-3472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10535R207P00000X
LAMD.10535R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1675211Medicaid
MS04609769Medicaid
LA5H4077061Medicare PIN
MS04609769Medicaid