Provider Demographics
NPI:1225376536
Name:GOTTSEGEN, WARREN L
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:L
Last Name:GOTTSEGEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 DUBOIS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-5038
Mailing Address - Country:US
Mailing Address - Phone:225-229-0048
Mailing Address - Fax:225-766-6783
Practice Address - Street 1:865 DUBOIS DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-5038
Practice Address - Country:US
Practice Address - Phone:225-229-0048
Practice Address - Fax:225-766-6783
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009444208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)