Provider Demographics
NPI:1972584746
Name:GUIDRY, LYNN M (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:M
Last Name:GUIDRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-526-0010
Mailing Address - Fax:225-765-9298
Practice Address - Street 1:109 ST. NAZAIRE ROAD
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518
Practice Address - Country:US
Practice Address - Phone:337-470-7580
Practice Address - Fax:337-839-0110
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA015417208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAE24244Medicare UPIN
LA55124DB95Medicare PIN