Provider Demographics
NPI:1235434556
Name:BEADLE, GABRIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:GABRIEL
Middle Name:
Last Name:BEADLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 N VICTOR II BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-1382
Mailing Address - Country:US
Mailing Address - Phone:985-412-2020
Mailing Address - Fax:985-259-8800
Practice Address - Street 1:1216 N VICTOR II BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-1382
Practice Address - Country:US
Practice Address - Phone:985-412-2020
Practice Address - Fax:985-259-8800
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA.200402363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical