Provider Demographics
NPI:1760703763
Name:BASRA, GURJOT KAUR (MD)
Entity Type:Individual
Prefix:DR
First Name:GURJOT
Middle Name:KAUR
Last Name:BASRA
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:PO BOX 122539 DEPT 2539
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2539
Mailing Address - Country:US
Mailing Address - Phone:337-494-2772
Mailing Address - Fax:337-494-2928
Practice Address - Street 1:2900 2ND AVE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8906
Practice Address - Country:US
Practice Address - Phone:337-480-8994
Practice Address - Fax:337-480-8993
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD207980207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2452266Medicaid
LAMD.207980OtherLSBME