Individual
JERRY W GAUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1140 BUSINESS CENTER DR, SUITE 370, HOUSTON, TX 77043-2737
(713) 271-6881
Mailing address
PO BOX 421756, HOUSTON, TX 77242-1756
(281) 880-6991
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
H9945
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00358430
RAILROAD MEDICARE
TX
Enumeration date
07/25/2006
Last updated
03/19/2009
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