Provider Demographics
NPI:1629041777
Name:RAYMOND, SIDNEY H (MD)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:H
Last Name:RAYMOND
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 1:1514 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70121-2429
Mailing Address - Country:US
Mailing Address - Phone:504-842-4000
Mailing Address - Fax:
Practice Address - Street 1:13100 RIVER RD
Practice Address - Street 2:SUITE 120
Practice Address - City:DESTREHAN
Practice Address - State:LA
Practice Address - Zip Code:70047-5219
Practice Address - Country:US
Practice Address - Phone:985-764-7669
Practice Address - Fax:985-764-7234
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023838207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1485501Medicaid
LA5E907DH01OtherMEDICARE PTAN
MS01381264Medicaid
LAH05633Medicare UPIN
MS01381264Medicaid