Provider Demographics
NPI:1336138494
Name:HILLIS, RODNEY E (MD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:E
Last Name:HILLIS
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 1:2647 S SAINT ELIZABETH BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-5017
Mailing Address - Country:US
Mailing Address - Phone:225-765-5500
Mailing Address - Fax:225-644-4206
Practice Address - Street 1:2647 S SAINT ELIZABETH BLVD
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-5021
Practice Address - Country:US
Practice Address - Phone:225-647-8511
Practice Address - Fax:225-644-5213
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1053632084N0400X
LAMD0242392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1573264Medicaid
10983217OtherCAQH
FL1464VOtherBC BS FL
FL7906337OtherCIGNA
LAH58327Medicare UPIN
LA4E1287545Medicare PIN