Provider Demographics
NPI:1760474084
Name:GUZZARDO, GEORGE NICK JR (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:NICK
Last Name:GUZZARDO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:34 CHATEAU LATOUR DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2021
Mailing Address - Country:US
Mailing Address - Phone:504-469-1201
Mailing Address - Fax:504-469-1201
Practice Address - Street 1:180 W ESPLANADE AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-2467
Practice Address - Country:US
Practice Address - Phone:504-464-8015
Practice Address - Fax:504-464-8538
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA13928207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1188654Medicaid
LAB63729Medicare UPIN
LA1188654Medicaid