Individual
GRANT GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2816 KINGSTON ST, SUITE C, KENNER, LA 70062-4995
(504) 408-0804
Mailing address
2816 KINGSTON ST, SUITE C, KENNER, LA 70062-4995
(504) 408-0804
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
026743
LA
Other
Enumeration date
08/01/2006
Last updated
01/23/2014
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