MEDICARE: DR. GAYLE HOLLEY BEYL 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	MD.206562	LA

General Provider Information

NPI Number	:	1710279195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAYLE HOLLEY BEYL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 3087
Second Line	:	SUITE 230
City	:	HAMMOND
State	:	LA
Zip	:	70404-3087
Country	:	US
Telephone Number	:	225-686-4982
Fax Number	:	225-686-4961

Provider Business Practice Location Address
First Line	:	17199 SPRING RANCH RD
Second Line	:	SUITE 200
City	:	LIVINGSTON
State	:	LA
Zip	:	70754-2900
Country	:	US
Telephone Number	:	225-686-4982
Fax Number	:	225-686-4961

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

Provider Enumeration Date	:	05/04/2011
Last Update Date	:	12/08/2022

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