Provider Demographics
NPI:1528359601
Name:ELIAS RAYMOND MOUNAYAR MD LLC
Entity Type:Organization
Organization Name:ELIAS RAYMOND MOUNAYAR MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIAS
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:MOUNAYAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-253-5600
Mailing Address - Street 1:158 KING ARTHUR DR
Mailing Address - Street 2:
Mailing Address - City:MANSURA
Mailing Address - State:LA
Mailing Address - Zip Code:71350-4484
Mailing Address - Country:US
Mailing Address - Phone:318-253-4814
Mailing Address - Fax:
Practice Address - Street 1:338 MOREAU ST
Practice Address - Street 2:SUITE D
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-2956
Practice Address - Country:US
Practice Address - Phone:318-253-5600
Practice Address - Fax:318-253-5602
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIAS RAYMOND MOUNAYAR MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1471771Medicaid
LA1471771Medicaid