Provider Demographics
NPI:1548253016
Name:GUIDRY, JIMMY NOOE (MD)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:NOOE
Last Name:GUIDRY
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 1:9233 N BERKLEY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2470
Mailing Address - Country:US
Mailing Address - Phone:225-342-3417
Mailing Address - Fax:225-342-4497
Practice Address - Street 1:8742 GOODWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7915
Practice Address - Country:US
Practice Address - Phone:225-231-7070
Practice Address - Fax:225-231-7069
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014578208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
5L803Medicare ID - Type Unspecified