Provider Demographics
NPI:1134190465
Name:COLPITTS, RALPH W (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:W
Last Name:COLPITTS
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 1:215 W PRIEN LAKE RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8450
Mailing Address - Country:US
Mailing Address - Phone:337-502-8706
Mailing Address - Fax:377-210-1271
Practice Address - Street 1:215 W PRIEN LAKE RD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8450
Practice Address - Country:US
Practice Address - Phone:337-502-8706
Practice Address - Fax:377-210-1271
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05703R2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1330663Medicaid
LA5BC59Medicare PIN
LA1330663Medicaid
LADG4253Medicare PIN