Provider Demographics
NPI:1306852751
Name:GUTGSELL, GREGORY R (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:GUTGSELL
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 1:3510 N CAUSEWAY BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3531
Mailing Address - Country:US
Mailing Address - Phone:504-831-3112
Mailing Address - Fax:504-831-3778
Practice Address - Street 1:2215 VETERANS MEMORIAL BLVD.
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-838-3524
Practice Address - Fax:504-828-6155
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.017684207P00000X
LA017684208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03777206Medicaid
LA1363588Medicaid
B63763Medicare UPIN
52310Medicare ID - Type Unspecified
LA4M4167061Medicare PIN