Basic Information
| Provider Information | |||||||||
| NPI: | 1659362960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGUILLARD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | NEAL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5050 POPLAR AVE | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381570101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012762662 | ||||||||
| FaxNumber: | 9012741871 | ||||||||
| Practice Location | |||||||||
| Address1: | 5050 POPLAR AVE | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381570101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012762662 | ||||||||
| FaxNumber: | 9012741871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 02/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 15930 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | 15930 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RC0200X | 15930 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3013886 | 05 | TN | MEDICAID |