Provider Demographics
NPI:1376525469
Name:MANUEL, GARY PAUL (MD)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:PAUL
Last Name:MANUEL
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 1:5705 COURTLAND PL
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2665
Mailing Address - Country:US
Mailing Address - Phone:318-443-2029
Mailing Address - Fax:
Practice Address - Street 1:501 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-8124
Practice Address - Country:US
Practice Address - Phone:318-487-1289
Practice Address - Fax:318-487-1254
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019448207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1912140Medicaid
5N457B312Medicare PIN
LA1912140Medicaid