Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 5565 | LA |
NPI | 1073741831 |
---|---|
Provider Name | Dr. Steven M. Gaudet |
First Address | Houma, LA 70360-6073 |
Second Address | Houma, LA 70360-6073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2009 |
Last Update Date | 30/06/2009 |