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General NPI Number Information
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NPI Number | 1487185955
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Entity Type | Organization
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Legal Business Name | PAUL GUILBAULT MD, FAMILY MEDICINE, LLC
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 521 ASBURY DRIVE
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City | MANDEVILLE
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State | LA
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Zip | 70471
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Country | US
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Telephone | 985-630-9618
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Fax | 985-231-7010
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Provider Business Mailing Address
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Address Line | 521 ASBURY DRIVE
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City | MANDEVILLE
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State | LA
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Zip | 70471
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Country | US
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Telephone | 985-630-9618
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Fax | 985-231-7010
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Authorized Official
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Title or Position | OWNER/PROPRIETOR
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Name | DR. ROBERT PAUL GUILBAULT III
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Credential | M.D.
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Telephone | 985-630-9618
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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 | 12621-R
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License Number State | LA
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