MEDICARE: JAMES WILLIAM GILLIAM II M.P.A.S., PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	000227	NY

General Provider Information

NPI Number	:	1386866796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WILLIAM GILLIAM II M.P.A.S., PA-C

Provider Business Mailing Address
First Line	:	PO BOX 792
Second Line	:
City	:	ROCK HILL
State	:	NY
Zip	:	12775-0792
Country	:	US
Telephone Number	:	645-544-1563
Fax Number	:

Provider Business Practice Location Address
First Line	:	USNS MOUNT BAKER T-AE 34
Second Line	:	MEDICAL DEPARTMENT
City	:	FPO
State	:	AE
Zip	:	09578-4047
Country	:	US
Telephone Number	:	732-866-7024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	04/20/2008

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