Provider Demographics
NPI:1780661181
Name:GUEVARA, RAUL BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:BENJAMIN
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62600
Mailing Address - Street 2:DEPT 1142
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70162-2600
Mailing Address - Country:US
Mailing Address - Phone:210-614-0180
Mailing Address - Fax:210-566-5698
Practice Address - Street 1:4200 HOUMA BLVD
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2970
Practice Address - Country:US
Practice Address - Phone:210-614-0180
Practice Address - Fax:210-566-5698
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013228207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1187810Medicaid
LAH4048ZOtherBCBS
LA1187810Medicaid
LAP00295986Medicare PIN
LA5H112Medicare PIN