Provider Demographics
NPI:1417081852
Name:ISERN, RAUL D JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:D
Last Name:ISERN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3438 FANNIN ST
Mailing Address - Street 2:BLDG. 3
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3803
Mailing Address - Country:US
Mailing Address - Phone:409-835-2677
Mailing Address - Fax:409-835-0464
Practice Address - Street 1:3438 FANNIN ST
Practice Address - Street 2:BLDG. 3
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3803
Practice Address - Country:US
Practice Address - Phone:409-835-2677
Practice Address - Fax:409-835-0464
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH34762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPOOOR26Y6Medicaid
TXPOOOR26Y6Medicaid
TXOOR294Medicare ID - Type Unspecified