Provider Demographics
NPI:1093288581
Name:RAVEY, CARL
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:RAVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 MANHATTAN BLVD STE J226
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-7300
Mailing Address - Country:US
Mailing Address - Phone:225-939-4904
Mailing Address - Fax:225-325-3667
Practice Address - Street 1:2736 ONEAL LN STE I
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-3186
Practice Address - Country:US
Practice Address - Phone:504-715-6658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies