Individual
CHARLES WAYNE GILLELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 COUNTRY CLUB DR, CORPUS CHRISTI, TX 78412-2828
(361) 992-3853
(361) 994-0981
Mailing address
100 COUNTRY CLUB DR, CORPUS CHRISTI, TX 78412-2828
(361) 992-3853
(361) 994-0981
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
E4353
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8P5503
BCBS PROVIDER NUMBER
TX
01
—
P00192827
RAILROAD MCARE PROV. NO.
TX
Enumeration date
10/11/2005
Last updated
07/09/2007
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