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General NPI Number Information
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NPI Number | 1871963942
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Entity Type | Individual
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Provider Name | FREDERICK DWAYNE GILLIAM PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 01/06/2025
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Provider Practice Location Address
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Address Line | 820 S AKERS ST STE 120
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City | VISALIA
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State | CA
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Zip | 93277-8306
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Country | US
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Telephone | 559-625-4118
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Fax | 559-625-6004
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Provider Business Mailing Address
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Address Line | 820 S AKERS ST STE 120
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City | VISALIA
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State | CA
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Zip | 93277-8306
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 52887
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 52887
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License Number State | CA
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