Individual
DEREK W GUILLORY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
202 FM 1346, SUITE 2, LA VERNIA, TX 78121
(830) 779-3200
(830) 779-3211
Mailing address
503 AVENUE A, SUITE 1118, SAN ANTONIO, TX 78215-1264
(210) 468-3042
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
L5751
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167798102
—
TX
05
—
167798105
—
TX
01
—
8M8130
BCBS
TX
Enumeration date
09/15/2005
Last updated
11/28/2016
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