Provider Demographics
NPI:1083713101
Name:LOUISIANA EAR, NOSE, & THROAT SPECIALISTS, INC.
Entity Type:Organization
Organization Name:LOUISIANA EAR, NOSE, & THROAT SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:T
Authorized Official - Last Name:GAUDET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-446-5079
Mailing Address - Street 1:604 N ACADIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4847
Mailing Address - Country:US
Mailing Address - Phone:985-446-5079
Mailing Address - Fax:985-447-2497
Practice Address - Street 1:604 N ACADIA RD STE 101
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-4847
Practice Address - Country:US
Practice Address - Phone:985-446-5079
Practice Address - Fax:985-447-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1797197Medicaid
LA56746Medicare ID - Type UnspecifiedCLINIC MEDICARE NUMBER