Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | D0139 | TX |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | D0139 | TX |
NPI | 1851464622 |
---|---|
Provider Name | Jim E Gilmore |
First Address | Dallas, TX 75390-7201 |
Second Address | Dallas, TX 75390-7201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 15/04/2016 |