Skip Navigation

Provider Information for 1003880956

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DUSTIN RAND GOUDEAU PAC

Gender: MALE

Individual NPI: 1003880956

Calendar   Last Updated:  2009-12-10
  Certification Date: 

Details

Name Value
NPI 1003880956
Enumeration Date 2006-02-16
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 3351 MASONIC DR
ALEXANDRIA, LA 71301-3842
United States

Phone: 318-473-9556 | Fax: 318-441-8339
View Map External Link
Primary Practice Address 3351 MASONIC DR
ALEXANDRIA, LA 71301-3842
United States

Phone: 318-473-9556 | Fax: 318-441-8339
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Other RAILROAD MEDICARE PALMETT LA P00246919
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 363A00000X - Physician Assistant LA PAA10612