Provider Demographics
NPI:1649242702
Name:GUILLORY, BRIAN ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:ALAN
Last Name:GUILLORY
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 1:110 LAKEVIEW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7511
Mailing Address - Country:US
Mailing Address - Phone:985-273-3000
Mailing Address - Fax:985-809-0425
Practice Address - Street 1:110 LAKEVIEW DR STE 200
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7511
Practice Address - Country:US
Practice Address - Phone:985-898-1940
Practice Address - Fax:985-809-0425
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020197207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG3579OtherBLUE CROSS/BLUE SHIELD
LA1929441Medicaid
LAF68987Medicare UPIN
LA5R967Medicare ID - Type UnspecifiedMEDICARE