Provider Demographics
NPI:1760625230
Name:GWIN, JODIE (MD)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:GWIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 E MAIN ST
Mailing Address - Street 2:200
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4046
Mailing Address - Country:US
Mailing Address - Phone:337-256-8779
Mailing Address - Fax:337-359-4997
Practice Address - Street 1:6 OAK PL
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-3087
Practice Address - Country:US
Practice Address - Phone:337-256-8779
Practice Address - Fax:337-359-4997
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206056207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1518697Medicaid
LA292582YJTEMedicare PIN