Healthcare Provider Details

I. General information

NPI: 1144210618
Provider Name (Legal Business Name): LOUIS BEN GAUDIN II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7968 GOODWOOD BLVD
BATON ROUGE LA
70806-7629
US

IV. Provider business mailing address

7968 GOODWOOD BLVD
BATON ROUGE LA
70806-7629
US

V. Phone/Fax

Practice location:
  • Phone: 225-923-3283
  • Fax: 225-923-3285
Mailing address:
  • Phone: 225-923-3283
  • Fax: 225-923-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberMD019883
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: