Provider Demographics
NPI:1558318212
Name:LYNN M. GUIDRY MD
Entity Type:Organization
Organization Name:LYNN M. GUIDRY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GUIDRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-839-2324
Mailing Address - Street 1:705 S MORGAN AVE
Mailing Address - Street 2:STE. B
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4951
Mailing Address - Country:US
Mailing Address - Phone:337-839-2324
Mailing Address - Fax:337-839-2325
Practice Address - Street 1:705 S MORGAN AVE
Practice Address - Street 2:STE. B
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518-4951
Practice Address - Country:US
Practice Address - Phone:337-839-2324
Practice Address - Fax:337-839-2325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1682721Medicaid
LA55124Medicare PIN