Healthcare Provider Details

I. General information

NPI: 1730406992
Provider Name (Legal Business Name): DR PATRICK S GILLESPIE A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N MAIN ST
WASHINGTON LA
70589-4282
US

IV. Provider business mailing address

PO BOX 698
WASHINGTON LA
70589-0698
US

V. Phone/Fax

Practice location:
  • Phone: 337-826-8044
  • Fax: 337-826-8048
Mailing address:
  • Phone: 337-826-8044
  • Fax: 337-826-8048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. PATRICK SEAN GILLESPIE
Title or Position: OWNER
Credential: MD
Phone: 337-826-8044