Provider Demographics
NPI:1528315280
Name:CALLAIS, GENE THOMAS JR (MD)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:THOMAS
Last Name:CALLAIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:805 ALBERTSON PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-4350
Mailing Address - Country:US
Mailing Address - Phone:337-470-3560
Mailing Address - Fax:337-837-2551
Practice Address - Street 1:811 D&E ALBERTSON PARKWAY
Practice Address - Street 2:
Practice Address - City:BROUSSARD
Practice Address - State:LA
Practice Address - Zip Code:70518
Practice Address - Country:US
Practice Address - Phone:337-470-3560
Practice Address - Fax:337-837-2551
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.207240207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2374991Medicaid