Provider Demographics
NPI:1407848146
Name:GUIDRY, KEVIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:GUIDRY
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 1:2000 TYBEE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4171
Mailing Address - Country:US
Mailing Address - Phone:337-433-7272
Mailing Address - Fax:337-433-0730
Practice Address - Street 1:2000 TYBEE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4171
Practice Address - Country:US
Practice Address - Phone:337-433-7272
Practice Address - Fax:337-433-0730
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024767207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1420956Medicaid
LA1420956Medicaid
LAH31877Medicare UPIN