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NPI Code Detail

MEDICARE: JONATHAN JAMES GILLMAN PA-C

MEDICARE: JONATHAN JAMES GILLMAN 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
1363A00000XPhysician Assistant50.002072OH

General Provider Information

NPI Number : 1750474821
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN JAMES GILLMAN PA-C
Provider Business Mailing Address
First Line : 6232 KARLSRIDGE DR
Second Line :
City : CENTERVILLE FINANCE
State : OH
Zip : 45459-8402
Country : US
Telephone Number : 937-436-5763
Fax Number : 937-436-7399
Provider Business Practice Location Address
First Line : 5491 FAR HILLS AVE
Second Line :
City : DAYTON
State : OH
Zip : 45429-2325
Country : US
Telephone Number : 937-436-5763
Fax Number : 937-436-7399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 07/08/2007

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Directions to “ JONATHAN JAMES GILLMAN PA-C” Practice Location

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