Individual
SAMUEL THOMAS GILLILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
NAVAL HOSPITAL JACKSONVILLE, 2080 CHILD ST, JACKSONVILLE, FL 32214-5000
(904) 542-3500
Mailing address
NAVAL HOSPITAL JACKSONVILLE, 2080 CHILD ST, JACKSONVILLE, FL 32214-5000
(904) 542-3500
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1710I1002X
INDEPENDENT DUTY CORPSMAN
—
Enumeration date
03/08/2006
Last updated
07/30/2012
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