Provider Demographics
NPI:1629004023
Name:STAAB, PAUL KRAY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KRAY
Last Name:STAAB
Suffix:
Gender:M
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:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70073-0247
Mailing Address - Country:US
Mailing Address - Phone:985-796-0904
Mailing Address - Fax:985-796-0904
Practice Address - Street 1:5216 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4248
Practice Address - Country:US
Practice Address - Phone:985-796-0904
Practice Address - Fax:985-796-0904
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017766207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1351768Medicaid
LAC67324Medicare UPIN
LA50084Medicare ID - Type Unspecified