Provider Demographics
NPI:1235166315
Name:GUILLORY, GERARD LIVAUDAIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:LIVAUDAIS
Last Name:GUILLORY
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:750 POTOMAC STREET
Mailing Address - Street 2:SUITE 111
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-6795
Mailing Address - Country:US
Mailing Address - Phone:303-343-3121
Mailing Address - Fax:303-343-2514
Practice Address - Street 1:750 POTOMAC STREET
Practice Address - Street 2:SUITE 111
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-6795
Practice Address - Country:US
Practice Address - Phone:303-343-3121
Practice Address - Fax:303-343-2514
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO26649207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO110238248OtherRAILROAD MEDICARE
CO01266493Medicaid
CO01266493Medicaid
COC474148Medicare PIN