Provider Demographics
NPI:1073696407
Name:PALACIOS MAYORGA, ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:PALACIOS MAYORGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ENRIQUE
Other - Middle Name:
Other - Last Name:PALACIOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:107 ENGLISH TURN DR
Mailing Address - Street 2:NEW ORLEANS
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3319
Mailing Address - Country:US
Mailing Address - Phone:504-384-0173
Mailing Address - Fax:504-392-2840
Practice Address - Street 1:1555 POYDRAS ST
Practice Address - Street 2:NEW ORLEANS
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-3701
Practice Address - Country:US
Practice Address - Phone:504-568-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13380R2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009941620Medicaid
LA1563587Medicaid
MS00922010Medicaid
AL009941620Medicaid
MS00922010Medicaid