Individual
DR. BRUCE L. GILLIAM
Active
Individual
DR. BRUCE L. GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
D50956
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1275583650
—
DE
05
—
182200400
—
MD
05
—
3810011136
—
WV
01
—
608175-01 & 02
BLUE CROSS/BLUE SHIELD
MD
Enumeration date
05/10/2006
Last updated
11/15/2010
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