Individual
GARY JOSEPH BIRDSALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
102 W 112TH ST, CUT OFF, LA 70345-3628
(985) 632-5222
(985) 632-4222
Mailing address
102 W 112TH ST, CUT OFF, LA 70345-3628
(985) 632-5222
(985) 632-4222
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
017642
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1366145
—
LA
Enumeration date
06/14/2006
Last updated
03/27/2014
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