Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 019054 | LA |
Y | 111NI0900X | Internist | 019054 | LA |
N | 207RH0002X | Hospice and Palliative Medicine | 019054 | LA |
NPI | 1326049545 |
---|---|
Provider Name | Dr. Brian Chris Gremillion |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Baton Rouge, LA 70809-3515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 25/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010057326 | RAILROAD MEDICARE (01) | LA |
1366218 | (05) | LA |
B89829 | (02) | LA |