Provider Demographics
NPI:1043585300
Name:ANTILL, TROY WILLIAM
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:WILLIAM
Last Name:ANTILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4446 SOUTHDOWN MANDALAY RD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-3011
Mailing Address - Country:US
Mailing Address - Phone:985-226-3779
Mailing Address - Fax:
Practice Address - Street 1:4446 SOUTHDOWN MANDALAY RD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-3011
Practice Address - Country:US
Practice Address - Phone:985-226-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.208097207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist