Individual
SHANE GILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
MSOAG, BLDG 202, CAMP LEJEUNE, NC 28540
(910) 449-9264
Mailing address
1104 CLAUDIA CT, JACKSONVILLE, NC 28540-3302
(224) 627-3254
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
12/26/2007
Last updated
12/26/2007
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