Provider Demographics
NPI:1912109018
Name:GILLILAND, LAWRENCE LEA COCKROFT (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:LEA COCKROFT
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:L
Other - Last Name:GILLILAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3262
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-3262
Mailing Address - Country:US
Mailing Address - Phone:417-885-3888
Mailing Address - Fax:417-881-7268
Practice Address - Street 1:3850 S NATIONAL AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5287
Practice Address - Country:US
Practice Address - Phone:417-269-6170
Practice Address - Fax:417-269-6992
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012474342085R0202X
MO20110178182085R0202X
TN390200000X2085U0001X
GA722422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound