Provider Demographics
NPI:1427178995
Name:RAUL D. ISERN JR M.D.P.A
Entity Type:Organization
Organization Name:RAUL D. ISERN JR M.D.P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ISERN
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:409-835-2677
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3476261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000R26Y6Medicaid
460-11-9818OtherSS#
TXE20056Medicare UPIN
TXP000R26Y6Medicaid