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Individual

P TRUETT RAY JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D

Contact information

Practice address
504 N ACADIA RD, THIBODAUX, LA 70301-4862
(985) 447-5667
(985) 447-5670
Mailing address
504 N ACADIA RD, THIBODAUX, LA 70301-4862
(985) 447-5667
(985) 447-5670

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
MD013941
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1333948
LA
01
4397691627A
BLUE CROSS BLUE SHIELD
LA
01
P00065497
RAILROAD MEDICARE
LA
Enumeration date
06/05/2006
Last updated
07/08/2007
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