Provider Demographics
NPI:1740290873
Name:GILLESPIE, ROBERT LEE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:GILLESPIE
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 1:16950 VIA TAZON
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-1607
Mailing Address - Country:US
Mailing Address - Phone:858-521-2340
Mailing Address - Fax:858-521-2024
Practice Address - Street 1:16950 VIA TAZON
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92127-1607
Practice Address - Country:US
Practice Address - Phone:858-521-2340
Practice Address - Fax:858-521-2024
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66094207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G660940Medicaid
CA00G660940Medicaid
CAF30630Medicare UPIN