Provider Demographics
NPI:1245237742
Name:REGIONAL UROLOGY LLC.
Entity Type:Organization
Organization Name:REGIONAL UROLOGY LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:D
Authorized Official - Last Name:GERMANY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-683-0411
Mailing Address - Street 1:255 BERT KOUNS LOOP
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-8150
Mailing Address - Country:US
Mailing Address - Phone:318-683-0411
Mailing Address - Fax:318-603-5461
Practice Address - Street 1:255 BERT KOUNS LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-8150
Practice Address - Country:US
Practice Address - Phone:318-683-0411
Practice Address - Fax:318-603-5461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1946982Medicaid
LACD4645OtherRAILROAD MEDICARE
LA5F786Medicare PIN