Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 025588 | LA |
NPI | 1255343786 |
---|---|
Provider Name | Gilbert P Pellerin SR. |
First Address | Abbeville, LA 70511-1152 |
Second Address | Abbeville, LA 70510-4039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1045675 | (05) | LA |
H83382 | (02) | LA |