Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 19349 | MS |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 203549 | LA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 29261 | AL |
NPI | 1912126723 |
---|---|
Provider Name | Jason Morgan Guillot |
First Address | Mandeville, LA 70471-3104 |
Second Address | Mandeville, LA 70471-3104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 26/02/2021 |