Individual
DR. GARY T GILLHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1229 E SEMINOLE ST, SUITE 420, SPRINGFIELD, MO 65804-2227
(417) 820-9393
(417) 820-9725
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 820-2000
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2008023553
MO
207W00000X
Ophthalmology Physician
36122133
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MO
Enumeration date
01/25/2007
Last updated
01/29/2015
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