Provider Demographics
NPI:1174591390
Name:GUIDRY, BRIAN PHILLIP (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PHILLIP
Last Name:GUIDRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740550
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70174
Mailing Address - Country:US
Mailing Address - Phone:504-366-7638
Mailing Address - Fax:
Practice Address - Street 1:95 E FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-867-4000
Practice Address - Fax:985-867-4001
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA24212207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1489654Medicaid
H39415Medicare UPIN
LA1489654Medicaid