Individual
SCOTT R GILLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
7925 YOUREE DR, SUITE 200, SHREVEPORT, LA 71105-5127
(318) 212-3610
(318) 212-3672
Mailing address
7925 YOUREE DR, SUITE 200, SHREVEPORT, LA 71105-5127
(318) 212-3610
(318) 212-3672
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA200106
LA
Other
Enumeration date
10/31/2006
Last updated
07/14/2021
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