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Individual

DR. RICHARD GENE GAYNOR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2320 DRUSILLA LN, SUITE B, BATON ROUGE, LA 70809-1495
(225) 924-7500
(225) 924-7501
Mailing address
2320 DRUSILLA LN, SUITE B, BATON ROUGE, LA 70809-1495
(225) 924-7500
(225) 924-7501

Taxonomy

Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD.015433
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
05756
BLUE CROSS
LA
05
1309001
LA
01
720957732
CHAMPUS
LA
Enumeration date
01/29/2007
Last updated
07/08/2007
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