Provider Demographics
NPI:1073661625
Name:GILMAN, DAVID CLARK (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CLARK
Last Name:GILMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 N VERCLER RD
Mailing Address - Street 2:BLDG 4
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1092
Mailing Address - Country:US
Mailing Address - Phone:509-924-4681
Mailing Address - Fax:509-922-7634
Practice Address - Street 1:N 1414 VERELER
Practice Address - Street 2:BLDG 4
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216
Practice Address - Country:US
Practice Address - Phone:509-924-4681
Practice Address - Fax:509-922-7634
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00D00778207Q00000X
ID028207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA17418OtherLABOR & INDUSTRY WASH
WA1030337Medicaid
ID003248500OtherMEDICAID
ID003248500OtherMEDICAID
WA17418OtherLABOR & INDUSTRY WASH