Healthcare Provider Details

I. General information

NPI: 1104862085
Provider Name (Legal Business Name): GULF SOUTH MEDICAL & SURGICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 FLORIDA AVE
KENNER LA
70065-3031
US

IV. Provider business mailing address

PO BOX 459
KENNER LA
70063-0459
US

V. Phone/Fax

Practice location:
  • Phone: 504-471-3100
  • Fax: 504-471-3109
Mailing address:
  • Phone: 504-471-3100
  • Fax: 504-471-3109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number207ND0900X
License Number StateLA

VIII. Authorized Official

Name: DR. GEORGE A. FARBER
Title or Position: DIRECTOR
Credential: M.D.
Phone: 504-471-3100