Provider Demographics
NPI:1649262916
Name:GUILLORY, WILLIAM R JR (MD, FACC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:GUILLORY
Suffix:JR
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HOSPITAL DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70503-2852
Mailing Address - Country:US
Mailing Address - Phone:337-236-3411
Mailing Address - Fax:337-236-3118
Practice Address - Street 1:155 HOSPITAL DR
Practice Address - Street 2:SUITE 203
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2852
Practice Address - Country:US
Practice Address - Phone:337-236-3411
Practice Address - Fax:337-236-3118
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016627207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1347728Medicaid
LA1347728Medicaid
LA5M517Medicare ID - Type Unspecified