Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | L3311 | TX |
NPI | 1376655936 |
---|---|
Provider Name | Jeffrey W Gilman |
First Address | Dallas, TX 75373-3784 |
Second Address | Fort Worth, TX 76104-2733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 26/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I10027 | (02) |