Healthcare Provider Details

I. General information

NPI: 1831402924
Provider Name (Legal Business Name): SOUTH LOUISIANA ENT, FACIAL PLASTIC & HAIR RESTORATION, APMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N CAUSEWAY BLVD
MANDEVILLE LA
70471-3104
US

IV. Provider business mailing address

1420 N CAUSEWAY BLVD
MANDEVILLE LA
70471-3104
US

V. Phone/Fax

Practice location:
  • Phone: 985-327-5905
  • Fax: 985-200-0840
Mailing address:
  • Phone: 985-327-5905
  • Fax: 985-200-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number203549
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number203549
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number203549
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number203549
License Number StateLA

VIII. Authorized Official

Name: JASON M GUILLOT
Title or Position: OWNER
Credential: MD
Phone: 985-327-5905