Provider Demographics
NPI:1326049545
Name:GREMILLION, BRIAN CHRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHRIS
Last Name:GREMILLION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 S SHERWOOD FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6038
Mailing Address - Country:US
Mailing Address - Phone:225-765-5727
Mailing Address - Fax:225-765-9196
Practice Address - Street 1:8119 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3515
Practice Address - Country:US
Practice Address - Phone:225-214-3638
Practice Address - Fax:225-214-3639
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019054207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA010057326OtherRAILROAD MEDICARE
LA1366218Medicaid
LA4M624DX80Medicare PIN
LA010057326OtherRAILROAD MEDICARE
LA55326D279Medicare PIN
LA1366218Medicaid