Provider Demographics
NPI:1780651737
Name:GILLES, PIERRE CLAUDE (MD)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:CLAUDE
Last Name:GILLES
Suffix:
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 1:5880 S HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:GLOBE
Mailing Address - State:AZ
Mailing Address - Zip Code:85501-9447
Mailing Address - Country:US
Mailing Address - Phone:928-402-1131
Mailing Address - Fax:928-425-7903
Practice Address - Street 1:4524 N MARYVALE PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1730
Practice Address - Country:US
Practice Address - Phone:623-535-4582
Practice Address - Fax:623-848-4399
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11263208600000X
IL036058048208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD43964Medicare UPIN
AZWDBWLMedicare ID - Type Unspecified