Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 41068 | KY |
N | 208600000X | Surgeon | 41068 | KY |
NPI | 1023016912 |
---|---|
Provider Name | Dr. George Stephen Gilliam |
First Address | Owensboro, KY 42303-1449 |
Second Address | Owensboro, KY 42303-1449 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 19/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000051542 | BS OF KY (01) | KY |
100329260B | (05) | IN |
611303681 | COMMERCIAL INSURANCE (01) | KY |
64228174 | (05) | KY |
C64685 | (02) | KY |