Provider Demographics
NPI:1942576855
Name:GAUTREAUX, LORI NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:NICOLE
Last Name:GAUTREAUX
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 1:4049 I 49 S SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-0757
Mailing Address - Country:US
Mailing Address - Phone:337-678-4401
Mailing Address - Fax:
Practice Address - Street 1:4049 I 49 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0757
Practice Address - Country:US
Practice Address - Phone:337-678-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-25
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA301091207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine