MEDICARE: J DEPAUL 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1992247183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	J DEPAUL GAUTREAUX

Provider Business Mailing Address
First Line	:	PO BOX 1451
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77251-1451
Country	:	US
Telephone Number	:	832-516-3292
Fax Number	:

Provider Business Practice Location Address
First Line	:	3016 BUCK ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77020-3821
Country	:	US
Telephone Number	:	832-516-3292
Fax Number	:

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

Provider Enumeration Date	:	11/05/2016
Last Update Date	:	11/05/2016

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