MEDICARE: DR. JOHN RUSSELL GILMORE M.D.

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	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	F9479	TX

General Provider Information

NPI Number	:	1194778928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN RUSSELL GILMORE M.D.

Provider Business Mailing Address
First Line	:	10740 N CENTRAL EXPY
Second Line	:	SUITE 120
City	:	DALLAS
State	:	TX
Zip	:	75231-2161
Country	:	US
Telephone Number	:	214-361-5285
Fax Number	:	214-946-7844

Provider Business Practice Location Address
First Line	:	10740 N CENTRAL EXPY
Second Line	:	SUITE 120
City	:	DALLAS
State	:	TX
Zip	:	75231-2161
Country	:	US
Telephone Number	:	214-361-5285
Fax Number	:	214-946-7844

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	05/10/2023

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