Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 248950 | NY |
N | 208600000X | Surgeon | 248950 | NY |
Y | 2086S0102X | Surgical Critical Care | 248950 | NY |
N | 2086S0127X | Trauma Surgeon | 248950 | NY |
NPI | 1033346531 |
---|---|
Provider Name | Dr. Charles Clayton Guidry JR. |
First Address | Los Angeles, CA 90055-2378 |
Second Address | Los Angeles, CA 90043-1853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 22/09/2016 |