| Mason Wade Rau, MD | |
|
2647 S Saint Elizabeth Blvd Ste 219, Gonzales, LA 70737-5020 | |
| (225) 647-8511 | |
| (225) 644-8358 |
| Full Name | Mason Wade Rau |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Location | 2647 S Saint Elizabeth Blvd Ste 219, Gonzales, Louisiana |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093274243 | NPI | - | NPPES |
| 2494970 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 330991 (Louisiana) | Primary |
| Entity Name | Our Lady Of The Lake Physician Group Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1033494943 PECOS PAC ID: 4587849781 Enrollment ID: O20120529000377 |
| Mailing Address | Practice Location Address |
|---|---|
| Mason Wade Rau, MD 5959 S Sherwood Forest Blvd, Baton Rouge, LA 70816-6038 Ph: (225) 647-8511 | Mason Wade Rau, MD 2647 S Saint Elizabeth Blvd Ste 219, Gonzales, LA 70737-5020 Ph: (225) 647-8511 |
Mydhili Kanumilli, M.D Internal Medicine Medicare: Medicare Enrolled Practice Location: 2647 S Saint Elizabeth Blvd, Gonzales, LA 70737 Phone: 225-647-8511 Fax: 225-644-5213 | |
Niksad Abraham, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 2647 S Saint Elizabeth Blvd Ste 300, Gonzales, LA 70737 Phone: 225-767-3900 Fax: 225-766-2226 | |
Dr. Gretchen Marie Yandle, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 2647 S Saint Elizabeth Blvd, Gonzales, LA 70737 Phone: 225-647-8511 Fax: 225-644-5213 | |
Dr. Rahil Devendra Shah, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 1014 Saint Clair Blvd Ste 3030, Gonzales, LA 70737 Phone: 225-765-5500 Fax: 225-743-2546 | |
Dr. Carlos R Vazquez, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 2211 S Burnside Ave, Ste 4, Gonzales, LA 70737 Phone: 225-647-1947 | |
Bernard B Brach, MD Internal Medicine Medicare: Medicare Enrolled Practice Location: 2647 S. St Elizabeth Blvd, Gonzales, LA 70737 Phone: 225-647-8511 Fax: 225-644-5213 |