Provider Demographics
NPI:1326008707
Name:GILLILLAND, JAMES LOUIS (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LOUIS
Last Name:GILLILLAND
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 1:1131 N YORK CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85213-5328
Mailing Address - Country:US
Mailing Address - Phone:480-964-4190
Mailing Address - Fax:
Practice Address - Street 1:1131 N YORK CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-5328
Practice Address - Country:US
Practice Address - Phone:480-964-4190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01610207K00000X
AZ005365207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A01444Medicare UPIN