Organization
DR JONATHAN J GISCLAIR APMC DBA LAFOURCHE PODIATRY CLINIC
Active
Other names
Lafourche Podiatry Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN JAMES GISCLAIR DPM (PRESIDENT)
(985) 325-3668
Entity
Organization
Contact information
Practice address
16148 W MAIN ST, CUT OFF, LA 70345-3511
(985) 325-3668
(985) 325-3670
Mailing address
PO BOX 1759, DEPARTMENT 952, HOUSTON, TX 77251-1759
(713) 554-5304
(713) 554-5324
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
PD0110
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1131211
—
LA
Enumeration date
10/10/2007
Last updated
01/15/2009
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