Healthcare Provider Details

I. General information

NPI: 1073710943
Provider Name (Legal Business Name): PAUL RICHARD BILLEAUD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 FILLINGIM ST MASTIN 315
MOBILE AL
36617-2238
US

IV. Provider business mailing address

8234 GARDENIA CT
DAPHNE AL
36526-4383
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7866
  • Fax:
Mailing address:
  • Phone: 251-625-1885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.28045
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: