MEDICARE: LISA CRAWFORD GAUTREAU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	14908R	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083614101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA CRAWFORD GAUTREAU MD

Provider Business Mailing Address
First Line	:	500 RUE DE LA VIE ST STE 305
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70817-5126
Country	:	US
Telephone Number	:	225-927-5480
Fax Number	:	225-925-0896

Provider Business Practice Location Address
First Line	:	9000 AIRLINE HWY
Second Line	:	SUITE 620
City	:	BATON ROUGE
State	:	LA
Zip	:	70815-4114
Country	:	US
Telephone Number	:	225-927-5480
Fax Number	:	225-925-0896

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/20/2012

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Directions to “ LISA CRAWFORD GAUTREAU MD” Practice Location

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