Individual
HOLLY ALENE GILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1501 KINGS HWY, DEPARTMENT OF PEDIATRICS, SHREVEPORT, LA 71103-4228
(318) 675-8600
(318) 675-8638
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 675-5000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
021335
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1936049
—
LA
01
—
5E511F600
MEDICARE - PTAN
LA
Enumeration date
07/16/2006
Last updated
07/14/2021
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