Provider Demographics
NPI:1104862085
Name:GULF SOUTH MEDICAL & SURGICAL INSTITUTE
Entity Type:Organization
Organization Name:GULF SOUTH MEDICAL & SURGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-471-3100
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70063-0459
Mailing Address - Country:US
Mailing Address - Phone:504-471-3100
Mailing Address - Fax:504-471-3109
Practice Address - Street 1:3705 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3031
Practice Address - Country:US
Practice Address - Phone:504-471-3100
Practice Address - Fax:504-471-3109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207ND0900X207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAB63463Medicare UPIN