Individual
INDIRA GAUTAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
327 IBERIA ST, SUITE #3A, YOUNGSVILLE, LA 70592-5738
(337) 857-3512
(337) 857-3513
Mailing address
327 IBERIA ST, SUITE #3A, YOUNGSVILLE, LA 70592-5738
(337) 857-3512
(337) 857-3513
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15134R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1191167
—
LA
Enumeration date
02/09/2006
Last updated
06/17/2014
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