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General NPI Number Information
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NPI Number | 1376689323
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Entity Type | Individual
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Provider Name | RICHARD GENE GAYNOR M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2320 DRUSILLA LN SUITE B
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City | BATON ROUGE
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State | LA
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Zip | 70809-1495
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Country | US
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Telephone | 225-924-7500
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Fax | 225-924-7501
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Provider Business Mailing Address
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Address Line | 2320 DRUSILLA LN SUITE B
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City | BATON ROUGE
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State | LA
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Zip | 70809-1495
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Country | US
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Telephone | 225-924-7500
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Fax | 225-924-7501
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD.015433
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License Number State | LA
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