Provider Demographics
NPI:1962442285
Name:GAUTREAUX, LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
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 1:4300 HOUMA BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2924
Mailing Address - Country:US
Mailing Address - Phone:504-503-6791
Mailing Address - Fax:504-503-6730
Practice Address - Street 1:3555 LOYOLA DR APT A
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-7706
Practice Address - Country:US
Practice Address - Phone:504-464-7729
Practice Address - Fax:504-464-6343
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10500R174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1490687Medicaid
LA1490687Medicaid
LA5Y601Medicare ID - Type Unspecified