MEDICARE: DONNA LYNN GILLIAM PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA03687	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	H0143584	OTHER	TX	DPS
2	PA03687	OTHER	TX	LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083726459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA LYNN GILLIAM PA-C

Provider Business Mailing Address
First Line	:	1215 E COURT ST
Second Line	:
City	:	SEGUIN
State	:	TX
Zip	:	78155-5129
Country	:	US
Telephone Number	:	830-303-9400
Fax Number	:	830-303-9420

Provider Business Practice Location Address
First Line	:	1761 HIGHWAY 46 W STE 104
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78132-4750
Country	:	US
Telephone Number	:	830-608-1575
Fax Number	:	830-608-0868

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/07/2023

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