Individual
JOHN S. GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20172 E STAGECOACH TRL, MAYER, AZ 86333-2357
(800) 288-6206
(800) 960-4547
Mailing address
15029 N THOMPSON PEAK PARKWAY, STE B-111 PMB 438, SCOTTSDALE, AZ 85260-2223
(405) 590-8861
(800) 960-4547
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
16226
OK
207Q00000X
Family Medicine Physician
Primary
41469
AZ
Other
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
Enumeration date
03/30/2006
Last updated
07/01/2020
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