Healthcare Provider Details

I. General information

NPI: 1376633115
Provider Name (Legal Business Name): GREGORY J ARDOIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 4TH ST 1A
ALEXANDRIA LA
71301-8421
US

IV. Provider business mailing address

201 4TH ST STE 1A
ALEXANDRIA LA
71301-8421
US

V. Phone/Fax

Practice location:
  • Phone: 318-769-5864
  • Fax: 318-769-3910
Mailing address:
  • Phone: 318-769-5864
  • Fax: 318-769-3910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number017631
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number017631
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: