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General NPI Number Information
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NPI Number | 1295231413
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Entity Type | Individual
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Provider Name | MR. BLAKE AARON GILLILAND
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Gender | Male
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Dates
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Enumeration Date | 04/05/2018
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 7703 FLOYD CURL DR.
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City | SAN ANTONIO
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State | TX
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Zip | 78229
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Country | US
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Telephone | 210-567-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 2104 FOREST BANK LN
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City | PEARLAND
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State | TX
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Zip | 77581-5283
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Country | US
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Telephone | 281-254-3911
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | S4954
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10062833
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License Number State | TX
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