Provider Demographics
NPI:1235232331
Name:GILLEAN, WILLIAM OTHO JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:OTHO
Last Name:GILLEAN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8000 DONORE PL APT 5
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2676
Mailing Address - Country:US
Mailing Address - Phone:210-349-0277
Mailing Address - Fax:
Practice Address - Street 1:8000 DONORE PL APT 5
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2676
Practice Address - Country:US
Practice Address - Phone:210-349-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC89812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry