Individual
MR. BENJAMIN BLAIR GAUTREAUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
C.R.N.A.
Contact information
Practice address
15790 PAUL VEGA MD DR, ANESTHESIA DEPARTMENT, HAMMOND, LA 70403-1434
(985) 230-1682
(985) 230-1617
Mailing address
PO BOX 2668, HAMMOND, LA 70404-2668
(985) 230-2198
(985) 230-2159
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP06520
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2157809
—
LA
01
—
AP06520
CRNA LICENSE
LA
Enumeration date
07/21/2011
Last updated
12/10/2013
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