Individual
DR. GORDON GREGORY GIDMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
204 ENERGY PKWY, SUITE B, LAFAYETTE, LA 70508-3816
(337) 269-0136
(337) 233-8525
Mailing address
106 FERNEWOOD DR, LAFAYETTE, LA 70503-8425
(337) 988-0642
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
012306
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5DC78
NEW GROUP PTAN
LA
01
—
5M407DC78
GROUP MEMBER PTAN
LA
Enumeration date
02/28/2007
Last updated
08/27/2008
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