1316024656 NPI number — DR. TERRY ALLEN GILLIAN MD FACS PC

Table of content: DR. TERRY ALLEN GILLIAN MD FACS PC (NPI 1316024656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316024656 NPI number — DR. TERRY ALLEN GILLIAN MD FACS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLIAN
Provider First Name:
TERRY
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD FACS PC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316024656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26687
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93729-6687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-448-8980
Provider Business Mailing Address Fax Number:
559-256-5105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1193 E HERNDON AVE
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-3156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-448-8980
Provider Business Practice Location Address Fax Number:
559-256-5105
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0122X , with the licence number:  A29523 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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