Individual
PHILLIP RAY BACILLA JR.
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3351 MASONIC DRIVE, ALEXANDRIA, LA 71301-3842
(318) 473-9556
(318) 441-8339
Mailing address
3351 MASONIC DRIVE, ALEXANDRIA, LA 71301-3842
(318) 473-9556
(318) 441-8339
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
MD 020542
LA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
MD020542
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1662496
—
LA
Enumeration date
03/02/2006
Last updated
09/11/2025
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