Basic Information
| Provider Information | |||||||||
| NPI: | 1497808000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DILLARD | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2101 HIGHWAY 90 | ||||||||
| Address2: | |||||||||
| City: | GAUTIER | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395535340 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2809 DENNY AVE | ||||||||
| Address2: | |||||||||
| City: | PASCAGOULA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395815301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2285882938 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 55309 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 17501 | NV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | CDR.00000037 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MED-PHYS-LIC-60287 | MT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 036.144854 | IL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | R7982 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 63182 | MN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 56006 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 27807 | WV | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 151474 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 16435 | MS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD-44552 | IA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 04-40312 | KS | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 15-320 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 21294 | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0120851 | 05 | MS | MEDICAID |