Provider Demographics
NPI:1538800255
Name:GAYDEN, DUANE THOMAS SR
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:THOMAS
Last Name:GAYDEN
Suffix:SR
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 1:110 KASEY ST
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5263
Mailing Address - Country:US
Mailing Address - Phone:504-710-4319
Mailing Address - Fax:
Practice Address - Street 1:110 KASEY ST
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5263
Practice Address - Country:US
Practice Address - Phone:504-710-4319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA008070701172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver