Provider Demographics
NPI:1912082009
Name:PENA, GERARD FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:FRANCIS
Last Name:PENA
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 1:1850 GAUSE BLVD E
Mailing Address - Street 2:STE. 301
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5442
Mailing Address - Country:US
Mailing Address - Phone:985-646-4400
Mailing Address - Fax:985-646-4408
Practice Address - Street 1:1850 GAUSE BLVD E
Practice Address - Street 2:STE. 301
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5442
Practice Address - Country:US
Practice Address - Phone:985-646-4400
Practice Address - Fax:985-646-4408
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016673207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1345181Medicaid
LA040003773OtherRAILROAD MEDICARE
LA$$$$$$$$$AOtherBLUE CROSS
LA1345181Medicaid
LA040003773OtherRAILROAD MEDICARE