Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1084 | TX |
N | 222Z00000X | Podiatrist | 1084 | TX |
N | 2081S0010X | Sports Medicine | 1084 | TX |
N | 213ES0000X | Sports Medicine | 1084 | TX |
Y | 213ES0131X | Foot Surgery | 1084 | TX |
NPI | 1144331083 |
---|---|
Provider Name | Dr. W. Brent Gillespie |
First Address | San Antonio, TX 78258-3454 |
Second Address | San Antonio, TX 78258-3454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 07/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
127195904 | (05) | TX |
T83576 | (02) | TX |