Individual
NATHAN GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-5015
Mailing address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(210) 292-6225
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
BP10053699
TX
207R00000X
Internal Medicine Physician
Primary
O-1131
ID
Other
Enumeration date
09/16/2015
Last updated
05/15/2020
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