Provider Demographics
NPI:1902898885
Name:GUIDRY, GEORGE G (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:G
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:155 HOSPITAL DR
Mailing Address - Street 2:STE 206
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2852
Mailing Address - Country:US
Mailing Address - Phone:337-234-3204
Mailing Address - Fax:337-234-3599
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:STE 206
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-234-3204
Practice Address - Fax:337-234-3599
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA018477207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1398489Medicaid
E06587Medicare UPIN
LA5J899Medicare ID - Type Unspecified