Provider Demographics
NPI:1942207782
Name:RALEIGH, EDWARD N (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:N
Last Name:RALEIGH
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 3758
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78463-3758
Mailing Address - Country:US
Mailing Address - Phone:361-992-4211
Mailing Address - Fax:361-992-3847
Practice Address - Street 1:3853 S ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1637
Practice Address - Country:US
Practice Address - Phone:361-992-4211
Practice Address - Fax:361-992-3847
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9418207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000BW014Medicaid
TXZ000BW014Medicaid
TXBW01Medicare ID - Type Unspecified