Healthcare Provider Details

I. General information

NPI: 1700380490
Provider Name (Legal Business Name): GAUTAM SHARMA MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W PINHOOK RD STE 304
LAFAYETTE LA
70503-2460
US

IV. Provider business mailing address

1000 W PINHOOK RD STE 304
LAFAYETTE LA
70503-2460
US

V. Phone/Fax

Practice location:
  • Phone: 337-703-4481
  • Fax:
Mailing address:
  • Phone: 337-703-4481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number343220
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: