Individual
DR. DALE GILLAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
23450 US HIGHWAY 160, WALSENBURG, CO 81089-9104
(719) 738-4588
(719) 738-4534
Mailing address
23500 US HIGHWAY 160, WALSENBURG, CO 81089-9524
(719) 738-5100
(719) 738-5138
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
33569
AZ
208600000X
Surgery Physician
Primary
53050
CO
208600000X
Surgery Physician
MD2012-0389
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
911190
—
AZ
Enumeration date
01/17/2006
Last updated
01/03/2014
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