Provider Demographics
NPI:1255343786
Name:PELLERIN, GILBERT P SR (MD)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:P
Last Name:PELLERIN
Suffix:SR
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 1152
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70511-1152
Mailing Address - Country:US
Mailing Address - Phone:337-898-6503
Mailing Address - Fax:337-898-6506
Practice Address - Street 1:118 N HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70510-4039
Practice Address - Country:US
Practice Address - Phone:337-893-6294
Practice Address - Fax:337-893-6369
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025588207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1045675Medicaid
LA4J664Medicare ID - Type UnspecifiedMEDICARE #
LAH83382Medicare UPIN