Individual
PAUL EDWIN GILLIAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2530 S TELSHOR BLVD, STE 207, LAS CRUCES, NM 88011-4951
(575) 556-6400
(575) 556-6405
Mailing address
PO BOX 6310, LAS CRUCES, NM 88006-6310
(575) 556-6400
(575) 556-6405
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
97-247
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10827331
—
NM
01
—
P00905172
RR MEDICARE
NM
Enumeration date
11/22/2005
Last updated
04/12/2016
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