Provider Demographics
NPI:1467421529
Name:GULOTTA, PAUL HENRY JR (MD, APMC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:HENRY
Last Name:GULOTTA
Suffix:JR
Gender:M
Credentials:MD, APMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2313 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4091
Mailing Address - Country:US
Mailing Address - Phone:337-364-1734
Mailing Address - Fax:337-364-4717
Practice Address - Street 1:2313 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4091
Practice Address - Country:US
Practice Address - Phone:337-364-1734
Practice Address - Fax:337-364-4717
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA017276207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1351989Medicaid
LA1351989Medicaid
LA5L417DC57Medicare PIN