Provider Demographics
NPI:1962424705
Name:BELGARD, TILDON KURT (MD)
Entity type:Individual
Prefix:
First Name:TILDON
Middle Name:KURT
Last Name:BELGARD
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:PO BOX 14849
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70898-4849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8591 UNITED PLAZA BOULEVARD
Practice Address - Street 2:UNISYS LOUISIANA MEDICAID
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70898
Practice Address - Country:US
Practice Address - Phone:800-877-0666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0189142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1928925Medicaid
D87041Medicare UPIN
LA1928925Medicaid