Healthcare Provider Details

I. General information

NPI: 1902898885
Provider Name (Legal Business Name): GEORGE G GUIDRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 HOSPITAL DR STE 206
LAFAYETTE LA
70503-2852
US

IV. Provider business mailing address

155 HOSPITAL DR STE 206
LAFAYETTE LA
70503-2852
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-3204
  • Fax: 337-234-3599
Mailing address:
  • Phone: 337-234-3204
  • Fax: 337-234-3599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number018477
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: