Provider Demographics
NPI:1497381453
Name:GUIDRY, CARRIE ELAINE (MD)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:ELAINE
Last Name:GUIDRY
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 1:4415 N PERSHING AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6955
Mailing Address - Country:US
Mailing Address - Phone:209-641-2881
Mailing Address - Fax:
Practice Address - Street 1:820 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHURCH POINT
Practice Address - State:LA
Practice Address - Zip Code:70525-4402
Practice Address - Country:US
Practice Address - Phone:337-270-9110
Practice Address - Fax:337-651-2923
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA338969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine