Provider Demographics
NPI:1861653842
Name:CHAIBAN, GASSAN MITRI (MD)
Entity Type:Individual
Prefix:
First Name:GASSAN
Middle Name:MITRI
Last Name:CHAIBAN
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 1:814 W MCNEESE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-5426
Mailing Address - Country:US
Mailing Address - Phone:337-602-8686
Mailing Address - Fax:337-419-1997
Practice Address - Street 1:814 W MCNEESE ST STE 100
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5426
Practice Address - Country:US
Practice Address - Phone:337-602-8686
Practice Address - Fax:337-419-1997
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206152207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2339869Medicaid
MS05425346Medicaid
LA299348YH3UMedicare PIN