Provider Demographics
NPI:1861497075
Name:SAGRERA, RALPH CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:CHARLES
Last Name:SAGRERA
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 1:29 FAIRWAY OAKS DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131
Mailing Address - Country:US
Mailing Address - Phone:504-304-7789
Mailing Address - Fax:504-304-7789
Practice Address - Street 1:29 FAIRWAY OAKS DRIVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131
Practice Address - Country:US
Practice Address - Phone:504-304-7789
Practice Address - Fax:504-304-7789
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009696208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1334359Medicaid
LA55439Medicare ID - Type Unspecified
B65740Medicare UPIN