Provider Demographics
NPI:1710197033
Name:LILES, WILLIAM B (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:B
Last Name:LILES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:312 GRAMMONT STREET
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201
Mailing Address - Country:US
Mailing Address - Phone:318-398-2984
Mailing Address - Fax:318-398-2413
Practice Address - Street 1:312 GRAMMONT STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-398-2984
Practice Address - Fax:318-398-2413
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2022-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA202468208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1079294Medicaid
LA1079294Medicaid