Provider Demographics
NPI:1316024656
Name:GILLIAN, TERRY ALLEN (MD FACS PC)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:ALLEN
Last Name:GILLIAN
Suffix:
Gender:M
Credentials:MD FACS PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26687
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-6687
Mailing Address - Country:US
Mailing Address - Phone:559-448-8980
Mailing Address - Fax:559-256-5105
Practice Address - Street 1:1193 E HERNDON AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3156
Practice Address - Country:US
Practice Address - Phone:559-448-8980
Practice Address - Fax:559-256-5105
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA295232086S0122X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A25799Medicare UPIN
CA00A295230Medicare ID - Type Unspecified