Individual
DR. LARRY S GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
10665
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00110281
—
MS
01
—
302I058786
MEDICARE PTAN
MS
01
—
3240993
CIGNA
MS
01
—
5171576
AETNA
MS
01
—
62904
UNITED HEALTHCARE
MS
Enumeration date
07/11/2006
Last updated
08/23/2016
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