Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G84341 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | G84341 | CA |
NPI | 1275536633 |
---|---|
Provider Name | Dr. Michael J. Gillman |
First Address | Orange, CA 92868-4246 |
Second Address | Orange, CA 92868-4246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2005 |
Last Update Date | 14/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G76305 | (02) | CA |