Provider Demographics
NPI:1629176615
Name:GUILBEAU, GARETT G (PA-C)
Entity Type:Individual
Prefix:
First Name:GARETT
Middle Name:G
Last Name:GUILBEAU
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 NORTH BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3658
Mailing Address - Country:US
Mailing Address - Phone:318-443-4576
Mailing Address - Fax:318-449-5579
Practice Address - Street 1:3704 NORTH BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3658
Practice Address - Country:US
Practice Address - Phone:318-443-4576
Practice Address - Fax:318-449-5579
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1069238363A00000X
LA200564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51534278OtherBCBS
AL051558599Medicare PIN
LA271731YPCHMedicare PIN