Healthcare Provider Details

I. General information

NPI: 1093974099
Provider Name (Legal Business Name): TAYLOR SCOTT GWIN MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE SUITE 310
BATON ROUGE LA
70809-3679
US

IV. Provider business mailing address

8585 PICARDY AVE SUITE 310
BATON ROUGE LA
70809-3679
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-5479
  • Fax: 225-767-5147
Mailing address:
  • Phone: 225-767-5479
  • Fax: 225-767-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD204029
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: