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NPI Code Detail

MEDICARE: DR. WENDY SUDDETH GERVAIS M.D.

MEDICARE: DR. WENDY SUDDETH GERVAIS 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
12085R0202XDiagnostic Radiology PhysicianMD.023887LA

Other Identifiers

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

General Provider Information

NPI Number : 1750467007
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WENDY SUDDETH GERVAIS M.D.
Provider Business Mailing Address
First Line : PO BOX 4051
Second Line :
City : HOUMA
State : LA
Zip : 70361-4051
Country : US
Telephone Number : 985-917-3007
Fax Number : 985-851-7526
Provider Business Practice Location Address
First Line : 128 NEUROSCIENCE CT
Second Line :
City : GRAY
State : LA
Zip : 70359-5209
Country : US
Telephone Number : 985-917-3007
Fax Number : 985-917-3010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2006
Last Update Date : 07/26/2016

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