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General NPI Number Information
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NPI Number | 1326179508
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Entity Type | Organization
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Legal Business Name | JOSEPH M GAUTREAUX, MD
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 01/07/2011
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Provider Practice Location Address
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Address Line | 1302 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70062
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Country | US
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Telephone | 504-464-8683
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Fax | 504-464-9100
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Provider Business Mailing Address
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Address Line | 1302 WILLIAMS BLVD
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City | KENNER
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State | LA
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Zip | 70062
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Country | US
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Telephone | 504-464-8683
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Fax | 504-464-9100
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH M GAUTREAUX, III III
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Credential | M.D.
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Telephone | 504-464-8683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD.013371
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 013371
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License Number State | LA
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