Provider Demographics
NPI:1720147580
Name:GAUTHIER, LEONARD LESTAN JR
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:LESTAN
Last Name:GAUTHIER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10534 BAYOU DES GLAISES ST
Mailing Address - Street 2:
Mailing Address - City:MOREAUVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71355-3038
Mailing Address - Country:US
Mailing Address - Phone:318-985-3950
Mailing Address - Fax:318-985-3950
Practice Address - Street 1:10534 BAYOU DES GLAISES ST
Practice Address - Street 2:
Practice Address - City:MOREAUVILLE
Practice Address - State:LA
Practice Address - Zip Code:71355-3038
Practice Address - Country:US
Practice Address - Phone:318-985-3950
Practice Address - Fax:318-985-3950
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist