Provider Demographics
NPI:1972669679
Name:GILLMAN, JOHN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:GILLMAN
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 1:2702 S 42ND ST STE 310
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-7324
Mailing Address - Country:US
Mailing Address - Phone:253-472-7844
Mailing Address - Fax:253-472-8474
Practice Address - Street 1:2702 S 42ND ST STE 310
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7324
Practice Address - Country:US
Practice Address - Phone:253-472-7844
Practice Address - Fax:253-472-8474
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9300475208100000X
WAMO60265170208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC35522OtherNC BC/BS
VA303273OtherANTHEM
VA2167789OtherUHC/MAMSI
NC8935522Medicaid
VA1972669679Medicaid
VA10019472OtherSENTARA/OPTIMA DAY REHAB
VA10019473OtherSENTARA/OPTIMA PHY MED
VA10019473OtherSENTARA/OPTIMA PHY MED
VAP00434465Medicare PIN