Healthcare Provider Details

I. General information

NPI: 1588914436
Provider Name (Legal Business Name): RONALD JOSEPH GAGNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 TOULOUSE ST UNIT BC-1
NEW ORLEANS LA
70112
US

IV. Provider business mailing address

1022 TOULOUSE ST UNIT BC-1
NEW ORLEANS LA
70112-3479
US

V. Phone/Fax

Practice location:
  • Phone: 504-558-9673
  • Fax: 504-558-9673
Mailing address:
  • Phone: 504-558-9673
  • Fax: 504-558-9673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.12831R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: