# JOHN S. GILLIAM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1003877085
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | 16226 | OK | — |
| 207Q00000X | Family Medicine Physician | 41469 | AZ | Yes |

## Other

- **Enumeration date:** 03/30/2006
- **Last updated:** 07/01/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100044450A | — | OK |
| 05 | — | 100044450B | — | OK |
| 01 | — | 600874 | AHCCCS (ARIZONA MEDICAID) ID | AZ |
| 01 | — | Z144938 | MEDICARE PTAN | AZ |