Organization
GUILLERMO FAMILY MEDICAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDRES J GUILLERMO M.D. (OWNER/PROVIDER)
(337) 460-7688
Entity
Organization
Contact information
Practice address
301 S WASHINGTON ST, SUITE A, DERIDDER, LA 70634-4861
(337) 460-7688
(337) 460-7691
Mailing address
301 S WASHINGTON ST, SUITE A, DERIDDER, LA 70634-4861
(337) 460-7688
(337) 460-7691
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD.203910
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1005690
—
LA
Enumeration date
11/09/2010
Last updated
11/09/2010
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