Provider Demographics
NPI:1124211099
Name:YANDLE, GRETCHEN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:MARIE
Last Name:YANDLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 S SAINT ELIZABETH BLVD
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5021
Mailing Address - Country:US
Mailing Address - Phone:225-647-8511
Mailing Address - Fax:225-644-5213
Practice Address - Street 1:2647 S SAINT ELIZABETH BLVD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5021
Practice Address - Country:US
Practice Address - Phone:225-647-8511
Practice Address - Fax:225-644-5213
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202808207RP1001X
LAPGY1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1007757Medicaid