Provider Demographics
NPI:1861479123
Name:GILLILAND, KATHRYN G (MD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:G
Last Name:GILLILAND
Suffix:
Gender:F
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:PO BOX 1648
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97440-1648
Mailing Address - Country:US
Mailing Address - Phone:541-342-2134
Mailing Address - Fax:541-686-6021
Practice Address - Street 1:920 COUNTRY CLUB RD
Practice Address - Street 2:STE 200A
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6024
Practice Address - Country:US
Practice Address - Phone:541-342-1234
Practice Address - Fax:541-686-6021
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18241207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR057872Medicaid
ORR137008Medicare PIN
F60651Medicare UPIN