Healthcare Provider Details

I. General information

NPI: 1093849515
Provider Name (Legal Business Name): FLOYD ANTHONY GASPARD JR. R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2770 3RD AVE SUITE 225
LAKE CHARLES LA
70601
US

IV. Provider business mailing address

PO BOX 122425 DEPT 2425
DALLAS TX
75312-2425
US

V. Phone/Fax

Practice location:
  • Phone: 337-494-3100
  • Fax: 337-494-3101
Mailing address:
  • Phone: 337-494-3100
  • Fax: 337-494-3101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN081384
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: