MEDICARE: JESSE GAUTREAUX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	214817	LA

General Provider Information

NPI Number	:	1548876188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE GAUTREAUX

Provider Business Mailing Address
First Line	:	7300 BURBANK DR APT 57
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70820-8730
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 GOVERNMENT ST STE 2
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-5755
Country	:	US
Telephone Number	:	225-900-8950
Fax Number	:	225-529-3880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	09/18/2020

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Directions to “ JESSE GAUTREAUX ” Practice Location

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