Organization
DR. GARY BIRDSALL MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BIRDSALL MD (MD/OWNER)
(985) 632-5222
Entity
Organization
Contact information
Practice address
102 W 112TH ST, CUT OFF, LA 70345-3628
(985) 632-5222
(985) 632-4222
Mailing address
102 W 112TH ST, CUT OFF, LA 70345-3628
(985) 632-5222
(985) 632-4222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366145
—
LA
Enumeration date
09/27/2013
Last updated
03/21/2014
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