Provider Demographics
NPI:1578677357
Name:GILLORY, DAVID O III (MD)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:O
Last Name:GILLORY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16020 PARK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3573
Mailing Address - Country:US
Mailing Address - Phone:512-244-0766
Mailing Address - Fax:512-244-1013
Practice Address - Street 1:16020 PARK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681
Practice Address - Country:US
Practice Address - Phone:512-244-0766
Practice Address - Fax:512-244-1013
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF1579207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C16123Medicare UPIN
892941Medicare ID - Type Unspecified