Provider Demographics
NPI:1467741785
Name:GULF SOUTH PHYSICIANS GROUP
Entity Type:Organization
Organization Name:GULF SOUTH PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:CEASAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-309-8135
Mailing Address - Street 1:3801 HOUMA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4165
Mailing Address - Country:US
Mailing Address - Phone:504-309-8135
Mailing Address - Fax:504-309-8156
Practice Address - Street 1:3801 HOUMA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4165
Practice Address - Country:US
Practice Address - Phone:504-309-8135
Practice Address - Fax:504-309-8156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD025275208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAH39423Medicare UPIN