Healthcare Provider Details

I. General information

NPI: 1235198599
Provider Name (Legal Business Name): GERARD GUIDRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 WALTERS ST
LAKE CHARLES LA
70607-4647
US

IV. Provider business mailing address

PO BOX 122108 DEPT 2108
DALLAS TX
75312-0001
US

V. Phone/Fax

Practice location:
  • Phone: 337-480-8066
  • Fax: 337-480-8061
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number020598
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: