Provider Demographics
NPI:1790180933
Name:BRIAN J GILLIS DO PA
Entity Type:Organization
Organization Name:BRIAN J GILLIS DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-465-3003
Mailing Address - Street 1:8 WATER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-4956
Mailing Address - Country:US
Mailing Address - Phone:207-465-3003
Mailing Address - Fax:207-465-7352
Practice Address - Street 1:8 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-4956
Practice Address - Country:US
Practice Address - Phone:207-465-3003
Practice Address - Fax:207-465-7352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1513208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherGEISINGER NPI ONLY