Healthcare Provider Details

I. General information

NPI: 1871591982
Provider Name (Legal Business Name): PAUL CARY AGUILLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 N BURNSIDE AVE
GONZALES LA
70737-2141
US

IV. Provider business mailing address

1702 N BURNSIDE AVE
GONZALES LA
70737-2141
US

V. Phone/Fax

Practice location:
  • Phone: 225-647-8319
  • Fax: 225-644-5213
Mailing address:
  • Phone: 225-647-8319
  • Fax: 225-644-5213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number09731R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number09731R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: