MEDICARE: ROSS GANUCHEAU MD

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	328782	LA

General Provider Information

NPI Number	:	1801383914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSS GANUCHEAU MD

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-765-5727
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	1810 LINDBERG DR STE 1100
Second Line	:
City	:	SLIDELL
State	:	LA
Zip	:	70458-8158
Country	:	US
Telephone Number	:	985-646-0945
Fax Number	:	985-643-8510

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

Provider Enumeration Date	:	04/16/2018
Last Update Date	:	05/18/2022

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