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General NPI Number Information
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NPI Number | 1730394545
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Entity Type | Organization
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Legal Business Name | GLEN G.GUILLET M.D.,P.A.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 5875 N MAJOR DR SUITE 214
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City | BEAUMONT
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State | TX
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Zip | 77713-9013
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Country | US
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Telephone | 409-896-5901
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Fax | 409-896-5910
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Provider Business Mailing Address
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Address Line | 5875 N MAJOR DR SUITE 214
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City | BEAUMONT
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State | TX
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Zip | 77713-9013
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Country | US
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Telephone | 409-896-5901
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Fax | 409-896-5910
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Authorized Official
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Title or Position | CEO
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Name | DR. GLEN G GUILLET
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Credential | M.D.
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Telephone | 409-896-5901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | D2455
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License Number State | TX
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