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General NPI Number Information
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NPI Number | 1063426005
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Entity Type | Individual
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Provider Name | MICHAEL WILLIAM GILLILAND M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1322 3RD ST SE SUITE 100
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City | PUYALLUP
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State | WA
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Zip | 98372-3771
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Country | US
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Telephone | 253-697-4128
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Fax |
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Provider Business Mailing Address
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Address Line | 1498 SE TECH CENTER PL SUITE 340
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City | VANCOUVER
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State | WA
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Zip | 98683-9591
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Country | US
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Telephone | 360-260-0235
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD00042973
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License Number State | WA
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