Provider Demographics
NPI:1215044219
Name:GILLARD, MARIJAN (MD)
Entity Type:Individual
Prefix:
First Name:MARIJAN
Middle Name:
Last Name:GILLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 SAN PEDRO
Mailing Address - Street 2:STE. 405
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6235
Mailing Address - Country:US
Mailing Address - Phone:210-344-2673
Mailing Address - Fax:210-344-2649
Practice Address - Street 1:7330 SAN PEDRO
Practice Address - Street 2:STE. 405
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6235
Practice Address - Country:US
Practice Address - Phone:210-344-2673
Practice Address - Fax:210-344-2649
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174873301Medicaid
TX174873301Medicaid