Provider Demographics
NPI:1992807812
Name:GOURI, THATTIL PAVUNNY (MD)
Entity type:Individual
Prefix:DR
First Name:THATTIL
Middle Name:PAVUNNY
Last Name:GOURI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:121 ENGLISH TURN DR
Mailing Address - Street 2:THATTIL P GOURI MD
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:79131
Mailing Address - Country:US
Mailing Address - Phone:504-392-2231
Mailing Address - Fax:504-362-8486
Practice Address - Street 1:3201 GENERAL MEYER AVE
Practice Address - Street 2:STE C
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70114
Practice Address - Country:US
Practice Address - Phone:504-362-8930
Practice Address - Fax:504-362-8486
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA04552R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1942111OtherCLINIC
LA1194620Medicaid