Provider Demographics
NPI:1033346531
Name:GUIDRY, CHARLES CLAYTON JR (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CLAYTON
Last Name:GUIDRY
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 55378
Mailing Address - Street 2:#4105
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90055-2378
Mailing Address - Country:US
Mailing Address - Phone:281-989-5952
Mailing Address - Fax:
Practice Address - Street 1:5141 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-1853
Practice Address - Country:US
Practice Address - Phone:800-831-4767
Practice Address - Fax:909-338-9883
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-11
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY248950208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery