Provider Demographics
NPI:1396725719
Name:TOWNSEND, GAULT HENRY (MD)
Entity type:Individual
Prefix:
First Name:GAULT
Middle Name:HENRY
Last Name:TOWNSEND
Suffix:
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 1:830 BAYOU PINES DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601
Mailing Address - Country:US
Mailing Address - Phone:337-436-9557
Mailing Address - Fax:337-439-3085
Practice Address - Street 1:830 BAYOU PINES DR
Practice Address - Street 2:THE PATHOLOGY LABORATORY
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601
Practice Address - Country:US
Practice Address - Phone:337-436-9557
Practice Address - Fax:337-439-3085
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017778207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1392146Medicaid
E27171Medicare UPIN
LA5L091Medicare ID - Type Unspecified