Provider Demographics
NPI:1083683627
Name:DAIGLE, GAYLON (MD)
Entity type:Individual
Prefix:
First Name:GAYLON
Middle Name:
Last Name:DAIGLE
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 1:2508 BERT KOUNS LOOP
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3133
Mailing Address - Country:US
Mailing Address - Phone:318-212-5343
Mailing Address - Fax:318-212-5360
Practice Address - Street 1:2508 BERT KOUNS LOOP
Practice Address - Street 2:SUITE 207
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3133
Practice Address - Country:US
Practice Address - Phone:318-212-5343
Practice Address - Fax:318-212-5343
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA011602207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1329258Medicaid
LA51511Medicare PIN
B63118Medicare UPIN
LA51511CP65Medicare PIN