Provider Demographics
NPI:1750701421
Name:GULLATT, THOMAS RYAN (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RYAN
Last Name:GULLATT
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 1:8401 PICARDY AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3685
Mailing Address - Country:US
Mailing Address - Phone:225-308-0247
Mailing Address - Fax:225-308-0249
Practice Address - Street 1:8401 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3685
Practice Address - Country:US
Practice Address - Phone:225-308-0247
Practice Address - Fax:225-308-0249
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10050266207R00000X
TXR2112207RC0000X
LA326260207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease