Provider Demographics
NPI:1720088529
Name:GAHAN, WILLIAM PATRICK (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:GAHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:W
Other - Middle Name:PATRICK
Other - Last Name:GAHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5247 DIDESSE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-9153
Mailing Address - Country:US
Mailing Address - Phone:225-765-3076
Mailing Address - Fax:225-765-3090
Practice Address - Street 1:5247 DIDESSE DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-9153
Practice Address - Country:US
Practice Address - Phone:225-765-3076
Practice Address - Fax:225-765-3090
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04634R207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1196550Medicaid
LA380001857OtherRAILROAD MEDICARE
LA1196550Medicaid
LAE04983Medicare UPIN