Basic Information
| Provider Information | |||||||||
| NPI: | 1396712808 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GURTLER | ||||||||
| FirstName: | JAYNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3939 HOUMA BLVD | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048850577 | ||||||||
| FaxNumber: | 5048887441 | ||||||||
| Practice Location | |||||||||
| Address1: | 3939 HOUMA BLVD | ||||||||
| Address2: | SUITE 6 | ||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5048850577 | ||||||||
| FaxNumber: | 5048887441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 04/03/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | L012803 | LA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 3600023 | 01 | LA | UNITED HEALTHCARE | OTHER | 4013223 | 01 | LA | AETNA | OTHER | 52365D287 | 01 | LA | MEDICARE GROUP | OTHER | 2705290005 | 01 | LA | CIGNA | OTHER |