Provider Demographics
NPI:1871591982
Name:AGUILLARD, PAUL CARY (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:CARY
Last Name:AGUILLARD
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 1:1702 N BURNSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-2141
Mailing Address - Country:US
Mailing Address - Phone:225-647-8319
Mailing Address - Fax:225-644-5213
Practice Address - Street 1:1702 N BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-2141
Practice Address - Country:US
Practice Address - Phone:225-647-8319
Practice Address - Fax:225-644-5213
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09731R207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1984329Medicaid
LAF75769Medicare UPIN
LA31529Medicare ID - Type Unspecified