Individual
DIANA L GILLMORE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
985 ROBERT BLVD, #103, SLIDELL, LA 70458-2063
(985) 646-1884
(985) 646-1885
Mailing address
985 ROBERT BLVD, #103, SLIDELL, LA 70458-2063
(985) 646-1884
(985) 646-1885
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
05478R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1363367
—
LA
01
—
39700
BCBS
LA
01
—
721142319
TAX ID
LA
Enumeration date
10/13/2005
Last updated
07/08/2007
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