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General NPI Number Information
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NPI Number | 1750701421
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Entity Type | Individual
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Provider Name | THOMAS RYAN GULLATT MD
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Gender | Male
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 8401 PICARDY AVE
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City | BATON ROUGE
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State | LA
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Zip | 70809-3685
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Country | US
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Telephone | 225-308-0247
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Fax | 225-308-0249
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Provider Business Mailing Address
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Address Line | 8401 PICARDY AVE
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City | BATON ROUGE
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State | LA
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Zip | 70809-3685
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Country | US
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Telephone | 225-308-0247
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Fax | 225-308-0249
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | BP10050266
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | R2112
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | 326260
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License Number State | LA
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