Provider Demographics
NPI:1477187433
Name:GILLESPIE, AUSTIN DANIEL
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:DANIEL
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36481 EAGLE LN
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-8007
Mailing Address - Country:US
Mailing Address - Phone:909-557-3529
Mailing Address - Fax:
Practice Address - Street 1:48745 3 POINTS RD
Practice Address - Street 2:
Practice Address - City:LAKE HUGHES
Practice Address - State:CA
Practice Address - Zip Code:93532-1122
Practice Address - Country:US
Practice Address - Phone:866-402-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other