Provider Demographics
NPI:1649460239
Name:GAUTHIER, CARL M JR (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:M
Last Name:GAUTHIER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 3087
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-230-1835
Mailing Address - Fax:985-230-1836
Practice Address - Street 1:15813 PAUL VEGA MD DR STE 400
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1431
Practice Address - Country:US
Practice Address - Phone:985-230-1835
Practice Address - Fax:985-230-1836
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAMD.201999207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1077330Medicaid
LA4Q402-5D628Medicare PIN