Provider Demographics
NPI:1629098660
Name:GUERIN, GERARD G (DPM)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:G
Last Name:GUERIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47026 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-7323
Mailing Address - Country:US
Mailing Address - Phone:601-362-3158
Mailing Address - Fax:601-987-8800
Practice Address - Street 1:5787 S HAMPTON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-2255
Practice Address - Country:US
Practice Address - Phone:601-362-3158
Practice Address - Fax:601-987-8800
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
MS80070213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP00218384OtherRAILROAD MEDICARE
LA1323462Medicaid
MS00015989Medicaid
LA1323462Medicaid
1239200001Medicare NSC
LA56020Medicare PIN
MS480000147Medicare PIN