Provider Demographics
NPI:1922020775
Name:GISCLAIR, JONATHAN JAMES (DPM)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:JAMES
Last Name:GISCLAIR
Suffix:
Gender:M
Credentials:DPM
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 1759
Mailing Address - Street 2:DEPARTMENT 952
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77251-1759
Mailing Address - Country:US
Mailing Address - Phone:713-554-5304
Mailing Address - Fax:713-554-5324
Practice Address - Street 1:16148 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CUT OFF
Practice Address - State:LA
Practice Address - Zip Code:70345
Practice Address - Country:US
Practice Address - Phone:985-325-3668
Practice Address - Fax:985-325-3670
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD0110213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1131211Medicaid
LA5CS61Medicare PIN
LA1131211Medicaid
LA5579250001Medicare NSC
U90841Medicare UPIN