Provider Demographics
NPI:1447251996
Name:DILLON, ILEY FLOYD (MD)
Entity type:Individual
Prefix:DR
First Name:ILEY
Middle Name:FLOYD
Last Name:DILLON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FRONT ST
Mailing Address - Street 2:SUITE 2109
Mailing Address - City:VIDALIA
Mailing Address - State:LA
Mailing Address - Zip Code:71373-2836
Mailing Address - Country:US
Mailing Address - Phone:318-336-2215
Mailing Address - Fax:318-336-6074
Practice Address - Street 1:107 FRONT ST
Practice Address - Street 2:SUITE 2109
Practice Address - City:VIDALIA
Practice Address - State:LA
Practice Address - Zip Code:71373-2836
Practice Address - Country:US
Practice Address - Phone:318-336-2215
Practice Address - Fax:318-336-6074
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL013367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0126495OtherMISS MEDICAID
LAB30193Medicare UPIN
LA1191311Medicare ID - Type Unspecified
LA4E187Medicare ID - Type Unspecified