Provider Demographics
NPI:1740598457
Name:VALENTIN, GARDY (MD)
Entity Type:Individual
Prefix:
First Name:GARDY
Middle Name:
Last Name:VALENTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4962 FLORIDA BLVD
Mailing Address - Street 2:SUITE 402
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-4031
Mailing Address - Country:US
Mailing Address - Phone:225-663-2445
Mailing Address - Fax:225-663-2419
Practice Address - Street 1:4962 FLORIDA BLVD
Practice Address - Street 2:SUITE 402
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4031
Practice Address - Country:US
Practice Address - Phone:225-663-2445
Practice Address - Fax:225-663-2419
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS21282207Q00000X
LA205405207Q00000X
NJ25MA08826900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0428311Medicaid
LA2195859Medicaid
NJ426029ZQAYMedicare PIN
NJ0428311Medicaid