Provider Demographics
NPI:1699822635
Name:GILLEAN, JOHN ALEX III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEX
Last Name:GILLEAN
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2540
Mailing Address - Fax:469-282-2540
Practice Address - Street 1:919 HIDDEN RDG
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-3813
Practice Address - Country:US
Practice Address - Phone:469-282-2540
Practice Address - Fax:469-282-2540
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG7812207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
51873Medicare ID - Type Unspecified