Provider Demographics
NPI:1851517734
Name:CLEMENT, DIXIE GUILLOT (MD)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:GUILLOT
Last Name:CLEMENT
Suffix:
Gender:F
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:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:MARKSVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71351-1140
Mailing Address - Country:US
Mailing Address - Phone:318-253-6016
Mailing Address - Fax:
Practice Address - Street 1:4218 HIGHWAY 1192
Practice Address - Street 2:
Practice Address - City:MARKSVILLE
Practice Address - State:LA
Practice Address - Zip Code:71351-4710
Practice Address - Country:US
Practice Address - Phone:318-240-1959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1066648Medicaid
LA4K674Medicare PIN
LA4K674C822Medicare PIN
LA4K674CY87Medicare PIN
LA1066648Medicaid