Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 01610 | IA |
Y | 207KA0200X | Allergist | 005365 | AZ |
NPI | 1326008707 |
---|---|
Provider Name | James Louis Gillilland |
First Address | Mesa, AZ 85213-5328 |
Second Address | Mesa, AZ 85213-5328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 03/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A01444 | (02) |