Provider Demographics
NPI:1447265178
Name:ARIAS, GERARDO (MD)
Entity type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:
Last Name:ARIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70302-5478
Mailing Address - Country:US
Mailing Address - Phone:985-493-4787
Mailing Address - Fax:985-449-2560
Practice Address - Street 1:608 N ACADIA RD
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-493-4787
Practice Address - Fax:985-449-2560
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20981207RH0003X
LAMD.13251R207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009900935Medicaid
LA1579106Medicaid
AL51509139OtherBCBS-BOAZ
AL009981760Medicaid
AL51509138OtherBCBS-FORT PAYNE
ALH649Medicare ID - Type UnspecifiedGROUP
ALG526Medicare ID - Type UnspecifiedGROUP
AL009981760Medicaid
LA4R133DL06Medicare PIN
AL51509138OtherBCBS-FORT PAYNE
LA1579106Medicaid