Organization Active NPI

Joseph M Gautreaux, MD

  • Otolaryngology Physician
  • Kenner, LA
National Provider Identifier
1326179508
Registry record updated Jan 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
013371 Issued in LA
Legal business name
JOSEPH M GAUTREAUX, MD
Practice address
1302 Williams Blvd
Kenner, LA 70062
Phone
(504) 464-8683
Fax
(504) 464-9100
NPI assigned
Mar 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joseph M Gautreaux, III III, M.D.
Title
Owner
Phone
(504) 464-8683

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X MD.013371 LA
Otolaryngology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Y00000X 013371 LA Primary

Addresses

Primary practice location

1302 Williams Blvd
Kenner, LA 70062

Mailing address

1302 Williams Blvd
Kenner, LA 70062
Phone (504) 464-8683

Other identifiers 1

IdentifierTypeStateIssuer
1307505MedicaidLA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D0457773Joseph M Gautreaux III MD1302 Williams Blvd, Kenner, LA 70062Certificate of waiverJul 8, 2028

National Provider Directory

National Provider Directory

Locations

200 W Esplanade Ave
Ste 120
Kenner, LA 70065
Phone (504) 821-8158

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294358400000",
    "number": "1326179508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1302 WILLIAMS BLVD",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "70062",
            "telephone_number": "504-464-8683",
            "fax_number": "504-464-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1302 WILLIAMS BLVD",
            "city": "KENNER",
            "state": "LA",
            "postal_code": "70062",
            "telephone_number": "504-464-8683",
            "fax_number": "504-464-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOSEPH M GAUTREAUX, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2011-01-07",
        "status": "A",
        "authorized_official_last_name": "GAUTREAUX, III",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "504-464-8683",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "LA",
            "license": "MD.013371",
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": "LA",
            "license": "013371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1307505",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenner, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.