Provider Demographics
NPI:1467475475
Name:GAUTHIER, CRAIG MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:MICHAEL
Last Name:GAUTHIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 N LEWIS ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2094
Mailing Address - Country:US
Mailing Address - Phone:337-367-1291
Mailing Address - Fax:337-365-8421
Practice Address - Street 1:520 N LEWIS ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2094
Practice Address - Country:US
Practice Address - Phone:337-367-9411
Practice Address - Fax:337-256-8892
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA09814R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1684864Medicaid
G29381Medicare UPIN