1881779775 NPI number — DR. EDWARD WILLIAM GILLILAND REL.D/ D.MIN

Table of content: DR. EDWARD WILLIAM GILLILAND REL.D/ D.MIN (NPI 1881779775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881779775 NPI number — DR. EDWARD WILLIAM GILLILAND REL.D/ D.MIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLILAND
Provider First Name:
EDWARD
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
REL.D/ D.MIN
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:
1881779775
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 CHAMBERS
Provider Second Line Business Mailing Address:
SUITE 5 P.O. BOX 3303
Provider Business Mailing Address City Name:
EAGLE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81631-3303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-328-1503
Provider Business Mailing Address Fax Number:
970-328-3302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 CHAMBERS
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
EAGLE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81631-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-328-1503
Provider Business Practice Location Address Fax Number:
970-328-3302
Provider Enumeration Date:
10/26/2006

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: 106H00000X , with the licence number:  0215 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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