MEDICARE: DR. SHAWN GAUTREAUX

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	183500000X	Pharmacist	40756	TX

General Provider Information

NPI Number	:	1376018754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAWN GAUTREAUX

Provider Business Mailing Address
First Line	:	3606 SKYLINE DR
Second Line	:
City	:	MANVEL
State	:	TX
Zip	:	77578-3241
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9230 KIRBY DR STE 500
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2593
Country	:	US
Telephone Number	:	713-634-1600
Fax Number	:

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

Provider Enumeration Date	:	10/11/2018
Last Update Date	:	10/11/2018

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Directions to “ DR. SHAWN GAUTREAUX ” Practice Location

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