Healthcare Provider Details

I. General information

NPI: 1154817195
Provider Name (Legal Business Name): CARLEY A GILMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2018
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS PL STE 3S34
SAINT LOUIS MO
63110-1002
US

IV. Provider business mailing address

3434 SHENANDOAH AVE APT 5
SAINT LOUIS MO
63104-1780
US

V. Phone/Fax

Practice location:
  • Phone: 314-454-6006
  • Fax:
Mailing address:
  • Phone: 615-904-4532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018021480
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: