Individual
DR. DALE GILLAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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