Provider Demographics
NPI:1720285158
Name:GILLEN, ARIC CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:ARIC
Middle Name:CHRISTOPHER
Last Name:GILLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:205 E UNIVERSITY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-6821
Mailing Address - Country:US
Mailing Address - Phone:877-800-5722
Mailing Address - Fax:512-869-2940
Practice Address - Street 1:3950 N A W GRIMES BLVD STE N103
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-3540
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:512-218-1249
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0827207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339843003Medicaid
TXTXB137065Medicare PIN