Individual
DR. W. BRENT GILLESPIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
19222 STONEHUE STE 104, SAN ANTONIO, TX 78258-3454
(210) 490-6408
(210) 490-6419
Mailing address
19222 STONEHUE STE 104, SAN ANTONIO, TX 78258-3454
(210) 490-6408
(210) 490-6419
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
1084
TX
213ES0000X
Sports Medicine Podiatrist
1084
TX
213ES0131X
Foot Surgery Podiatrist
Primary
1084
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
127195904
—
TX
Enumeration date
08/31/2006
Last updated
01/07/2010
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