Provider Demographics
NPI:1093933103
Name:NEWELL E. GAUTHIER, JR. MD
Entity Type:Organization
Organization Name:NEWELL E. GAUTHIER, JR. MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEWELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:318-876-3696
Mailing Address - Street 1:912 BRYAN ST.
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327
Mailing Address - Country:US
Mailing Address - Phone:318-876-3696
Mailing Address - Fax:318-876-3211
Practice Address - Street 1:912 BRYAN ST.
Practice Address - Street 2:
Practice Address - City:COTTONPORT
Practice Address - State:LA
Practice Address - Zip Code:71327
Practice Address - Country:US
Practice Address - Phone:318-876-3696
Practice Address - Fax:318-876-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA109261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448575Medicaid
LA193869Medicare Oscar/Certification