Organization
GASTROENTEROLOGY CLINIC, A PROFESSIONAL MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDREW W. WALDO (ADMINISTRATOR)
(318) 325-2634
Entity
Organization
Contact information
Practice address
611 GRAMMONT ST, MONROE, LA 71201-7516
(318) 325-2634
(318) 812-1205
Mailing address
611 GRAMMONT ST, MONROE, LA 71201-7516
(318) 325-2634
(318) 812-1205
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1798240
—
LA
01
—
23704
BLUE CROSS OF LOUISIANA
—
Enumeration date
07/28/2005
Last updated
07/21/2022
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