Provider Demographics
NPI:1861500753
Name:GILLILAND, RICHARD E (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:GILLILAND
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 1:985 NINTH AVENUE S.W.
Mailing Address - Street 2:SUITE 308
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022
Mailing Address - Country:US
Mailing Address - Phone:205-481-7780
Mailing Address - Fax:205-481-7740
Practice Address - Street 1:985 NINTH AVENUE S.W.
Practice Address - Street 2:SUITE 308
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022
Practice Address - Country:US
Practice Address - Phone:205-481-7780
Practice Address - Fax:205-481-7740
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00012109207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL040013385OtherRAILROAD MEDICARE
AL51045124OtherBLUE CROSS
ALC71208OtherVIVA
AL1010135OtherUNITED HEALTHCARE
ALC71208OtherHEALTHSPRING OF ALABAMA
AL000045124Medicaid
ALC71208OtherHEALTHSPRING OF ALABAMA
AL51045124OtherBLUE CROSS