Provider Demographics
NPI:1932146131
Name:GAUTHIER, NEWELL ERWIN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:NEWELL
Middle Name:ERWIN
Last Name:GAUTHIER
Suffix:JR
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:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:COTTONPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71327-0489
Mailing Address - Country:US
Mailing Address - Phone:318-876-3696
Mailing Address - Fax:
Practice Address - Street 1:912 BRYAN ST
Practice Address - Street 2:
Practice Address - City:COTTONPORT
Practice Address - State:LA
Practice Address - Zip Code:71327-4288
Practice Address - Country:US
Practice Address - Phone:318-876-3696
Practice Address - Fax:318-876-3211
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD011868207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1949876Medicaid
LA1949876Medicaid
B62787Medicare UPIN