Provider Demographics
NPI:1215939558
Name:GUILLOT, DAVID J (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:GUILLOT
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 1:2900 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-4605
Mailing Address - Country:US
Mailing Address - Phone:504-575-3712
Mailing Address - Fax:504-575-3691
Practice Address - Street 1:9372 HIGHWAY 165 S
Practice Address - Street 2:
Practice Address - City:WOODWORTH
Practice Address - State:LA
Practice Address - Zip Code:71485-9786
Practice Address - Country:US
Practice Address - Phone:318-484-9588
Practice Address - Fax:318-484-9590
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD022865207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1494437Medicaid
LAG44012Medicare UPIN
LA5Y314Medicare ID - Type Unspecified