Organization
INDIRA GAUTAM MD A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. INDIRA GAUTAM MD (OWNER)
(337) 857-3512
Entity
Organization
Contact information
Practice address
327 IBERIA ST, SUITE 3A, YOUNGSVILLE, LA 70592-6370
(337) 857-3512
Mailing address
327 IBERIA ST, SUITE 3A, YOUNGSVILLE, LA 70592-6370
(337) 857-3512
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
09/24/2014
Last updated
09/24/2014
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