Individual
DOUGLAS TERRY GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
780 S WALNUT ST, SUITE 3, LAS CRUCES, NM 88001-1425
(505) 525-3980
(505) 526-8529
Mailing address
780 S WALNUT ST, SUITE 3, LAS CRUCES, NM 88001-1425
(505) 525-3980
(505) 526-8529
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
196
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0469220001
DMERC
NM
01
—
16042
PRESBYTERIAN
NM
05
—
52993
—
NM
01
—
88001A00Z
TRICARE WPS
NM
01
—
NM005364
BC BS
NM
Enumeration date
08/24/2005
Last updated
10/29/2007
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