Individual
DR. CLINT C GUILLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2408 BROADMOOR BOULEVARD, SUITE 2, MONROE, LA 71201
(318) 807-7875
(318) 812-9997
Mailing address
130 DESIARD STREET, SUITE 355, MONROE, LA 71201
(318) 807-7875
(318) 812-9997
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
015565
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1351199
—
LA
05
—
1397261
—
LA
Enumeration date
01/02/2007
Last updated
01/06/2012
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