Provider Demographics
NPI:1295059228
Name:GILLS, JESSIE R (MD)
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:R
Last Name:GILLS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5215 ESSEN LN STE 200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3543
Mailing Address - Country:US
Mailing Address - Phone:225-215-1281
Mailing Address - Fax:225-215-1380
Practice Address - Street 1:2800 VETERANS MEMORIAL BLVD STE 140
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-6139
Practice Address - Country:US
Practice Address - Phone:225-767-0847
Practice Address - Fax:225-215-1380
Is Sole Proprietor?:No
Enumeration Date:2010-03-19
Last Update Date:2024-10-18
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Provider Licenses
StateLicense IDTaxonomies
LA205851208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2105094Medicaid