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NPI Code Detail

MEDICARE: SHANE GUILLORY M.D.

MEDICARE:   SHANE  GUILLORY  M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208M00000XHospitalist PhysicianMD.204994LA

General Provider Information

NPI Number : 1801037866
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANE GUILLORY M.D.
Provider Business Mailing Address
First Line : 252 METAIRIE HEIGHTS AVE
Second Line :
City : METAIRIE
State : LA
Zip : 70001-3037
Country : US
Telephone Number : 337-526-5329
Fax Number :
Provider Business Practice Location Address
First Line : 252 METAIRIE HEIGHTS AVE
Second Line :
City : METAIRIE
State : LA
Zip : 70001-3037
Country : US
Telephone Number : 337-526-5329
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2009
Last Update Date : 03/23/2012

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