Organization
GLEN G.GUILLET M.D.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN G GUILLET M.D. (CEO)
(409) 896-5901
Entity
Organization
Contact information
Practice address
5875 N MAJOR DR, SUITE 214, BEAUMONT, TX 77713-9013
(409) 896-5901
(409) 896-5910
Mailing address
5875 N MAJOR DR, SUITE 214, BEAUMONT, TX 77713-9013
(409) 896-5901
(409) 896-5910
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
D2455
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007PM
BCBS
TX
05
—
128065306
—
TX
Enumeration date
05/14/2007
Last updated
05/10/2011
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