| |
16148 W Main St, Cut Off, LA 70345-3511 | |
(985) 325-3668 | |
(985) 325-3670 |
Full Name | |
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Type | Facility |
Speciality | Podiatrist - Foot Surgery |
Location | 16148 W Main St, Cut Off, Louisiana |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1386832822 | NPI | - | NPPES |
1131211 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
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213ES0131X | Podiatrist - Foot Surgery | PD0110 (Louisiana) | Primary |
Provider Name | Jonathan J Gisclair |
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Provider Type | Practitioner - Podiatry |
Provider Identifiers | NPI Number: 1922020775 PECOS PAC ID: 0345261103 Enrollment ID: I20051208000789 |
Mailing Address | Practice Location Address |
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Po Box 1759, Department 952, Houston, TX 77251-1759 Ph: (713) 554-5304 | 16148 W Main St, Cut Off, LA 70345-3511 Ph: (985) 325-3668 |
Jonathan James Gisclair, DPM Podiatrist Medicare: Accepting Medicare Assignments Practice Location: 16148 West Main Street, Cut Off, LA 70345 Phone: 985-325-3668 Fax: 985-325-3670 |