Individual
CARLOS R GIMENEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
602 N ACADIA RD, THIBODAUX, LA 70301
(985) 447-5500
Mailing address
PO BOX 5478, THIBODAUX, LA 70302-5478
(985) 447-5500
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
13741R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1181919
—
LA
Enumeration date
03/02/2006
Last updated
06/28/2018
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