Provider Demographics
NPI:1225127509
Name:RARESHIDE, ELISABETH H (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:H
Last Name:RARESHIDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 NAPOLEON AVE
Mailing Address - Street 2:SUITE 820
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-6969
Mailing Address - Country:US
Mailing Address - Phone:504-895-7707
Mailing Address - Fax:504-895-7994
Practice Address - Street 1:2820 NAPOLEON AVE
Practice Address - Street 2:SUITE 820
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-6969
Practice Address - Country:US
Practice Address - Phone:504-895-7707
Practice Address - Fax:504-895-7994
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD018289207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA040014320OtherRAILROAD MEDICARE NUMBER
LA1366234Medicaid
LA52836Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
LA1366234Medicaid