MEDICARE: DR. LOUIS GEORGE GILLERAN 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	2083A0100X	Aerospace Medicine Physician	C51060	CA

General Provider Information

NPI Number	:	1831178334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS GEORGE GILLERAN M.D.

Provider Business Mailing Address
First Line	:	2725 E BAINBRIDGE RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-6070
Country	:	US
Telephone Number	:	619-795-6963
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 ROSECRANS ST
Second Line	:	SWMI, BLDG 500 NAVAL SUBMARINE BASE SAN DIEGO
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-4408
Country	:	US
Telephone Number	:	619-553-0097
Fax Number	:

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

Provider Enumeration Date	:	01/12/2006
Last Update Date	:	03/07/2023

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