Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | M1704 | TX |
N | 111NI0900X | Internist | M1704 | TX |
N | 207RX0202X | Medical Oncology | M1704 | TX |
NPI | 1033158472 |
---|---|
Provider Name | Dr. Arve Ward Gillette |
First Address | Dallas, TX 75391-1230 |
Second Address | Dallas, TX 75203-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 25/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
175736101 | (05) | TX |
175736102 | (05) | TX |
175736103 | (05) | TX |
8S7054 | BLUE CROSS OF TEXAS (01) | TX |
D56664 | (02) | TX |