Provider Demographics
NPI:1780785436
Name:PALISPIS, GLORIA RAPHEL (MD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:RAPHEL
Last Name:PALISPIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:CHURCH POINT
Mailing Address - State:LA
Mailing Address - Zip Code:70525-0182
Mailing Address - Country:US
Mailing Address - Phone:337-684-1010
Mailing Address - Fax:337-684-3813
Practice Address - Street 1:105 W EBEY ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-3523
Practice Address - Country:US
Practice Address - Phone:337-684-1010
Practice Address - Fax:337-684-3813
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA09321R207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1934682Medicaid
LAF33017Medicare UPIN
LA1934682Medicaid