Provider Demographics
NPI:1013936749
Name:GUILLIAMS, ERIC PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:PAUL
Last Name:GUILLIAMS
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:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3401 MCINTOSH CIR STE 200
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3604
Practice Address - Country:US
Practice Address - Phone:417-347-3703
Practice Address - Fax:417-347-3727
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004034152208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209408608Medicaid
MO927383268Medicare PIN
MO927383230Medicare PIN
MOH62692Medicare UPIN