Provider Demographics
NPI:1700143237
Name:GUIDRY, PAUL TAYLOR (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:TAYLOR
Last Name:GUIDRY
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 1:1500 LINE AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4648
Mailing Address - Country:US
Mailing Address - Phone:318-300-4926
Mailing Address - Fax:318-383-3951
Practice Address - Street 1:1500 LINE AVE STE 204
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4648
Practice Address - Country:US
Practice Address - Phone:318-300-4926
Practice Address - Fax:318-383-3951
Is Sole Proprietor?:No
Enumeration Date:2012-04-22
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA300758208M00000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program