Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | MD019883 | LA |
NPI | 1144210618 |
---|---|
Provider Name | Louis Ben Gaudin II |
First Address | Baton Rouge, LA 70806-7629 |
Second Address | Baton Rouge, LA 70806-7629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 22/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1651796 | (05) | LA |
DG5454 | RAILROAD MEDICARE (01) | LA |
F61437 | (02) | LA |