Healthcare Provider Details

I. General information

NPI: 1407198286
Provider Name (Legal Business Name): GARY STEPHEN MCDANIEL JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8585 PICARDY AVE STE 518
BATON ROUGE LA
70809-3748
US

IV. Provider business mailing address

8080 BLUEBONNET BLVD STE 1000
BATON ROUGE LA
70810-7827
US

V. Phone/Fax

Practice location:
  • Phone: 225-442-3166
  • Fax: 225-400-6495
Mailing address:
  • Phone: 225-442-3166
  • Fax: 225-400-6495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.207498
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD.207498
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD.207498
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: