Healthcare Provider Details

I. General information

NPI: 1558318212
Provider Name (Legal Business Name): LYNN M. GUIDRY MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 S MORGAN AVE STE. B
BROUSSARD LA
70518-4951
US

IV. Provider business mailing address

705 S MORGAN AVE STE. B
BROUSSARD LA
70518-4951
US

V. Phone/Fax

Practice location:
  • Phone: 337-839-2324
  • Fax: 337-839-2325
Mailing address:
  • Phone: 337-839-2324
  • Fax: 337-839-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNN M. GUIDRY
Title or Position: OWNER
Credential: M.D.
Phone: 337-839-2324