Provider Demographics
NPI:1568457315
Name:CAPITAINE, RAUL R (MD)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:R
Last Name:CAPITAINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 271190
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427-1190
Mailing Address - Country:US
Mailing Address - Phone:361-993-4835
Mailing Address - Fax:361-993-7043
Practice Address - Street 1:6000 S STAPLES ST
Practice Address - Street 2:#406
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-2952
Practice Address - Country:US
Practice Address - Phone:361-993-4835
Practice Address - Fax:361-993-7043
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH48852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122833005Medicaid
TX8AW409OtherBC/BS OF TX
TX122833005Medicaid