Individual
DR. BRIAN J GILLENWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2609 GLENN HENDREN DR, LIBERTY, MO 64068-3313
(816) 781-7730
(816) 415-1886
Mailing address
PO BOX 219672, KANSAS CITY, MO 64121-9672
(816) 781-7730
(816) 415-1886
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2010019019
MO
Other
Enumeration date
02/17/2012
Last updated
02/22/2017
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