Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | ME55597 | FL |
N | 207KA0200X | Allergist | ME55597 | FL |
NPI | 1285621573 |
---|---|
Provider Name | Dr. Robert Allen Gillham JR. |
First Address | Jacksonville, FL 32224-1865 |
Second Address | Jacksonville, FL 32224-1865 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09696 | BLUE CROSS/BLUS SHIELD (01) | FL |
E68166 | (02) | FL |