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General NPI Number Information
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NPI Number | 1396729711
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Entity Type | Individual
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Provider Name | GWENDOLYN L LAVALAIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 2450 N MAJOR DR
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City | BEAUMONT
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State | TX
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Zip | 77713-9575
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Country | US
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Telephone | 409-981-1800
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Fax | 409-981-1890
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Provider Business Mailing Address
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Address Line | 2450 N MAJOR DR
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City | BEAUMONT
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State | TX
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Zip | 77713-9575
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Country | US
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Telephone | 409-981-1800
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Fax | 409-981-1890
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | M0468
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License Number State | TX
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