Provider Demographics
NPI:1629246327
Name:MENDY, GABOU NDAPICH (MD, MPHTM,)
Entity Type:Individual
Prefix:
First Name:GABOU
Middle Name:NDAPICH
Last Name:MENDY
Suffix:
Gender:M
Credentials:MD, MPHTM,
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:EMMANUEL
Other - Last Name:MENDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPHTM
Mailing Address - Street 1:1706 GENERAL TAYLOR ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-4627
Mailing Address - Country:US
Mailing Address - Phone:504-298-4508
Mailing Address - Fax:
Practice Address - Street 1:1706 GENERAL TAYLOR ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-4627
Practice Address - Country:US
Practice Address - Phone:504-298-4508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06608R2083P0901X, 207Q00000X, 207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1352586Medicaid
LAB63390Medicare UPIN
LA1352586Medicaid