Provider Demographics
NPI:1710942065
Name:GAUTHREAUX, SCOTT THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:THOMAS
Last Name:GAUTHREAUX
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1101 S COLLEGE RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-3038
Mailing Address - Country:US
Mailing Address - Phone:337-232-2710
Mailing Address - Fax:337-232-6824
Practice Address - Street 1:1101 S COLLEGE RD
Practice Address - Street 2:SUITE 304
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-3038
Practice Address - Country:US
Practice Address - Phone:337-232-2710
Practice Address - Fax:337-232-6824
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA022261207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1429341Medicaid
LA1429341Medicaid
LAG50807Medicare UPIN
LA5H323Medicare ID - Type Unspecified