Provider Demographics
NPI:1265597819
Name:RAUL ENAD MD LLC
Entity type:Organization
Organization Name:RAUL ENAD MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:GALAGNARA
Authorized Official - Last Name:ENAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-723-5116
Mailing Address - Street 1:533 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2702
Mailing Address - Country:US
Mailing Address - Phone:636-723-5116
Mailing Address - Fax:636-896-9300
Practice Address - Street 1:533 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2702
Practice Address - Country:US
Practice Address - Phone:636-723-5116
Practice Address - Fax:636-896-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005031797207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty