Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 9222062-1205 | UT |
NPI | 1134216955 |
---|---|
Provider Name | Dr. John Lawrence Gililland JR. |
First Address | Sandy, UT 84092-4318 |
Second Address | Sandy, UT 84092-4318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 12/10/2018 |