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NPI Code Detail

MEDICARE: GARETT G GUILBEAU PA-C

MEDICARE:   GARETT G GUILBEAU  PA-C
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
1363A00000XPhysician Assistant1069238AL
2363A00000XPhysician Assistant200564LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
151534278OTHERALBCBS

General Provider Information

NPI Number : 1629176615
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARETT G GUILBEAU PA-C
Provider Business Mailing Address
First Line : 3704 NORTH BLVD
Second Line : SUITE C
City : ALEXANDRIA
State : LA
Zip : 71301-3658
Country : US
Telephone Number : 318-443-4576
Fax Number : 318-449-5579
Provider Business Practice Location Address
First Line : 3704 NORTH BLVD
Second Line : SUITE C
City : ALEXANDRIA
State : LA
Zip : 71301-3658
Country : US
Telephone Number : 318-443-4576
Fax Number : 318-449-5579
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 04/09/2013

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Directions to “ GARETT G GUILBEAU PA-C” Practice Location

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