Provider Demographics
NPI:1396779641
Name:CHRISTY, GILBERT KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:KEITH
Last Name:CHRISTY
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 1:2449 HOSPITAL DR STE 440
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1918
Mailing Address - Country:US
Mailing Address - Phone:318-212-7288
Mailing Address - Fax:318-212-7295
Practice Address - Street 1:2449 HOSPITAL DR STE 440
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1918
Practice Address - Country:US
Practice Address - Phone:318-212-7288
Practice Address - Fax:318-212-7295
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016819207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1354481Medicaid
5DE47Medicare PIN
LAD79740Medicare UPIN
LA1354481Medicaid