Healthcare Provider Details

I. General information

NPI: 1578776050
Provider Name (Legal Business Name): PULMONARY & DIGESTIVE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 E. HIGHWAY 30
GONZALES LA
70737
US

IV. Provider business mailing address

P.O. BOX 400
BRITTANY LA
70718-0400
US

V. Phone/Fax

Practice location:
  • Phone: 225-647-6900
  • Fax: 844-766-1659
Mailing address:
  • Phone: 225-647-6900
  • Fax: 844-766-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BOGDAN L NOWAKOWSKI
Title or Position: CEO, MD
Credential: M.D.
Phone: 225-647-6900