Provider Demographics
NPI:1831178334
Name:GILLERAN, LOUIS GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:GEORGE
Last Name:GILLERAN
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 1:2725 E BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-6070
Mailing Address - Country:US
Mailing Address - Phone:619-795-6963
Mailing Address - Fax:
Practice Address - Street 1:50 ROSECRANS ST
Practice Address - Street 2:SWMI, BLDG 500 NAVAL SUBMARINE BASE SAN DIEGO
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-4408
Practice Address - Country:US
Practice Address - Phone:619-553-0097
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC510602083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBG7448031OtherDEA NUMBER