Provider Demographics
NPI:1154599983
Name:PAUL H. GULOTTA, JR., M.D., A.P.M.C.
Entity type:Organization
Organization Name:PAUL H. GULOTTA, JR., M.D., A.P.M.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:GULOTTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:337-364-1734
Mailing Address - Street 1:2313 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70560-4091
Mailing Address - Country:US
Mailing Address - Phone:337-364-1734
Mailing Address - Fax:337-364-4717
Practice Address - Street 1:2313 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4091
Practice Address - Country:US
Practice Address - Phone:337-364-1734
Practice Address - Fax:337-364-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017276207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1351989Medicaid
LA1351989Medicaid
LA5DC57Medicare PIN