Provider Demographics
NPI:1053302398
Name:GILLUM, DAVID M (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:GILLUM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4891 INDEPENDENCE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6752
Mailing Address - Country:US
Mailing Address - Phone:303-456-5495
Mailing Address - Fax:303-456-7490
Practice Address - Street 1:5265 VANCE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3714
Practice Address - Country:US
Practice Address - Phone:303-232-3366
Practice Address - Fax:303-232-8734
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-10-20
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Provider Licenses
StateLicense IDTaxonomies
CO23221207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO390005661OtherRR MEDICARE
CO01232214Medicaid
CO390005661OtherRR MEDICARE
C225668Medicare PIN