# MR. JOHN BARTON GILLUM JR.

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

## Provider details

- **NPI number:** 1699752451
- **Gender:** Man
- **Credential:** PA

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | 1897 | CO | — |
| 363A00000X | Physician Assistant | 1897 | CO | — |
| 363A00000X | Physician Assistant | PA03173 | TX | Yes |

## Other

- **Enumeration date:** 12/22/2005
- **Last updated:** 06/04/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 119732100 | — | WY |
| 05 | — | 200039360A | — | OK |
| 05 | — | 200267860A | — | KS |
| 05 | — | 305251601 | — | TX |
| 05 | — | 46883355 | — | CO |
| 05 | — | 66478529 | — | NM |
| 01 | — | P00231064 | RR MEDICARE RIA | CO |