Healthcare Provider Details

I. General information

NPI: 1801383914
Provider Name (Legal Business Name): ROSS GANUCHEAU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 LINDBERG DR STE 1100
SLIDELL LA
70458-8158
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 985-646-0945
  • Fax: 985-643-8510
Mailing address:
  • Phone: 225-765-5727
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number328782
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: