Provider Demographics
NPI:1902850084
Name:GILLESPIE, PATRICK S (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:GILLESPIE
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 1:414 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70589-4282
Mailing Address - Country:US
Mailing Address - Phone:337-826-8044
Mailing Address - Fax:
Practice Address - Street 1:800 E MAIN ST
Practice Address - Street 2:
Practice Address - City:VILLE PLATTE
Practice Address - State:LA
Practice Address - Zip Code:70586-4618
Practice Address - Country:US
Practice Address - Phone:337-837-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-21
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021192207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1913677Medicaid
LAE69762Medicare UPIN
LA4A919Medicare PIN