Healthcare Provider Details

I. General information

NPI: 1326008707
Provider Name (Legal Business Name): JAMES LOUIS GILLILLAND DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 06/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 N YORK CIR
MESA AZ
85213-5328
US

IV. Provider business mailing address

1131 N YORK CIR
MESA AZ
85213-5328
US

V. Phone/Fax

Practice location:
  • Phone: 480-964-4190
  • Fax:
Mailing address:
  • Phone: 480-964-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number01610
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number005365
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: