Individual
MR. BLAKE AARON GILLILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7703 FLOYD CURL DR., SAN ANTONIO, TX 78229
(210) 567-1183
Mailing address
2104 FOREST BANK LN, PEARLAND, TX 77581-5283
(281) 254-3911
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
S4954
TX
390200000X
Student in an Organized Health Care Education/Training Program
BP10062833
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BP10062833
TEXAS PHYSICIAN IN TRAINING PERMIT
TX
01
—
S4954
STATE
TX
Enumeration date
04/05/2018
Last updated
07/14/2020
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