Provider Demographics
NPI:1285668467
Name:GUOTH, JANOS G (MD)
Entity Type:Individual
Prefix:
First Name:JANOS
Middle Name:G
Last Name:GUOTH
Suffix:
Gender:M
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:PO BOX 293
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-0293
Mailing Address - Country:US
Mailing Address - Phone:318-283-3634
Mailing Address - Fax:318-283-3888
Practice Address - Street 1:425 S VINE ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-4513
Practice Address - Country:US
Practice Address - Phone:318-281-8555
Practice Address - Fax:318-281-3850
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33343207V00000X
FLME 0067036207V00000X
HI11234207V00000X
LA14422R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1108324Medicaid
LA1108324Medicaid
LA4E005DP13Medicare PIN