Individual
DR. LAWRENCE M GILLIARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
925 N SPRING GARDEN AVE, DELAND, FL 32720
(386) 734-0348
(386) 740-7649
Mailing address
606 S LAKE VICTORIA CIR, DELAND, FL 32724-7718
(407) 222-1645
(386) 917-0335
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
ME37633
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0670065-00
—
FL
01
—
4122666
AETNA HMO
FL
01
—
59286
BC BS PROVIDER NUMBER
FL
01
—
593708866
TAX ID
FL
Enumeration date
08/10/2005
Last updated
03/26/2015
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