MEDICARE: DR. GERARD LAWRENCE GUDERIAN M.D.

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	207Q00000X	Family Medicine Physician	J8561	TX

General Provider Information

NPI Number	:	1134127244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARD LAWRENCE GUDERIAN M.D.

Provider Business Mailing Address
First Line	:	1108 GULF FWY S
Second Line	:	STE 240
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5100
Country	:	US
Telephone Number	:	281-557-4404
Fax Number	:	281-557-4443

Provider Business Practice Location Address
First Line	:	1108 GULF FWY S
Second Line	:	STE 240
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-5100
Country	:	US
Telephone Number	:	281-557-4404
Fax Number	:	281-557-4443

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	11/15/2012

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