Provider Demographics
NPI:1104947175
Name:GUILLORY, RYAN M (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:M
Last Name:GUILLORY
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 1:912 WALNUT HILL DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5052
Mailing Address - Country:US
Mailing Address - Phone:903-291-6300
Mailing Address - Fax:903-291-6305
Practice Address - Street 1:912 WALNUT HILL DR
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-5052
Practice Address - Country:US
Practice Address - Phone:903-291-6300
Practice Address - Fax:903-291-6305
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8298207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology