Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | A29523 | CA |
NPI | 1316024656 |
---|---|
Provider Name | Dr. Terry Allen Gillian |
First Address | Fresno, CA 93729-6687 |
Second Address | Fresno, CA 93720-3156 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 30/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A25799 | (02) |