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Individual
DOUGLAS TERRY GILLIS
Active
Individual
DOUGLAS TERRY GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
196
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0469220001
DMERC
NM
01
—
16042
PRESBYTERIAN
NM
05
—
52993
—
NM
01
—
88001A00Z
TRICARE WPS
NM
01
—
NM005364
BC BS
NM
Enumeration date
08/24/2005
Last updated
10/29/2007
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