Provider Demographics
NPI:1417959412
Name:RADER, ALLISON Z (MD)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:Z
Last Name:RADER
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 1:295 INDEST ST
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-1719
Mailing Address - Country:US
Mailing Address - Phone:337-365-0268
Mailing Address - Fax:337-369-6922
Practice Address - Street 1:295 INDEST ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-1719
Practice Address - Country:US
Practice Address - Phone:337-365-0268
Practice Address - Fax:337-369-6922
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025652208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1047708Medicaid