Healthcare Provider Details

I. General information

NPI: 1972584746
Provider Name (Legal Business Name): LYNN M. GUIDRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 ST. NAZAIRE ROAD
BROUSSARD LA
70518
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-7580
  • Fax: 337-839-0110
Mailing address:
  • Phone: 225-526-0010
  • Fax: 225-765-9298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number015417
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: