Provider Demographics
NPI:1588634554
Name:GUIDRY, BRET (MD)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:
Last Name:GUIDRY
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 1:1642 ESSEX HALL DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3997
Mailing Address - Country:US
Mailing Address - Phone:910-584-0359
Mailing Address - Fax:
Practice Address - Street 1:502 CHERRY RD STE 201
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3118
Practice Address - Country:US
Practice Address - Phone:910-584-0359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.13334R207V00000X, 2084P0800X
NC2013-019302084P0800X
LA13334R208D00000X
SC840502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice