Individual
JARED GILMORE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
604 N ACADIA RD, STE 409, THIBODAUX, LA 70301-4897
(985) 449-4670
(985) 449-2598
Mailing address
PO BOX 5478, STE 409, THIBODAUX, LA 70302-5478
(985) 449-4670
(985) 449-2598
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
020594
LA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
020594
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1902560
—
LA
Enumeration date
01/30/2006
Last updated
02/08/2017
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