Healthcare Provider Details

I. General information

NPI: 1255302378
Provider Name (Legal Business Name): JAMES KEVIN GILMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 ROGER BROOKE DR MCHE-QD (CREDS)
FORT SAM HOUSTON TX
78234-4501
US

IV. Provider business mailing address

3851 ROGER BROOKE DR MCHE-QD (CREDS)
FORT SAM HOUSTON TX
78234-4501
US

V. Phone/Fax

Practice location:
  • Phone: 210-916-4100
  • Fax: 210-916-2100
Mailing address:
  • Phone: 210-916-4100
  • Fax: 210-916-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01028591A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: