Healthcare Provider Details

I. General information

NPI: 1518259258
Provider Name (Legal Business Name): DILLON PAUL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5246 BRITTANY DR
BATON ROUGE LA
70808-9136
US

IV. Provider business mailing address

5246 BRITTANY DR
BATON ROUGE LA
70808-9136
US

V. Phone/Fax

Practice location:
  • Phone: 225-757-4140
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberQ9876
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD.207232
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: