Provider Demographics
NPI:1073704391
Name:GREMILLION, LORETTA PYLANT (MD)
Entity Type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:PYLANT
Last Name:GREMILLION
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1868 FORSYTHE AVE
Mailing Address - Street 2:STE 335
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3540
Mailing Address - Country:US
Mailing Address - Phone:318-251-6216
Mailing Address - Fax:318-251-6257
Practice Address - Street 1:2409 BROADMOOR BLVD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-2964
Practice Address - Country:US
Practice Address - Phone:318-323-8799
Practice Address - Fax:318-323-8815
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2018-06-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA026501207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1059587Medicaid
LA4N1007387OtherMEDICARE