Provider Demographics
NPI:1336318906
Name:PADILLA GUZMAN, EFRAIN (MD)
Entity Type:Individual
Prefix:DR
First Name:EFRAIN
Middle Name:
Last Name:PADILLA GUZMAN
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 1:4806 WELLINGTON BLVD # 162
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2519
Mailing Address - Country:US
Mailing Address - Phone:318-290-9603
Mailing Address - Fax:
Practice Address - Street 1:2495 SHREVEPORT HWY # 162
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4044
Practice Address - Country:US
Practice Address - Phone:318-290-9603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17040208D00000X
MI4301117215208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice