Provider Demographics
NPI:1619912631
Name:GILLILAND, GRANT D (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:D
Last Name:GILLILAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9301 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 595
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-0806
Mailing Address - Country:US
Mailing Address - Phone:214-522-7733
Mailing Address - Fax:214-521-5433
Practice Address - Street 1:9301 N CENTRAL EXPY
Practice Address - Street 2:SUITE 595
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-0806
Practice Address - Country:US
Practice Address - Phone:214-522-7733
Practice Address - Fax:214-521-5433
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH6240207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138928012Medicaid
00K86TMedicare ID - Type Unspecified
E33296Medicare UPIN