Provider Demographics
NPI:1649439605
Name:RAIFORD, LOUIS EUGENE (IDC)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:EUGENE
Last Name:RAIFORD
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 HERITAGE OAK DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-9501
Mailing Address - Country:US
Mailing Address - Phone:910-478-6773
Mailing Address - Fax:
Practice Address - Street 1:217 HERITAGE OAK DR
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-9501
Practice Address - Country:US
Practice Address - Phone:910-478-6773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman