Individual
MR. JOHN BARTON GILLUM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
MADIGAN ARMY MEDICAL CTR, 9040 A REID ST, TACOMA, WA 98431-0001
(253) 968-1110
Mailing address
MADIGAN ARMY MEDICAL CTR, 9040 A REID ST, TACOMA, WA 98431-0001
(253) 968-1110
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
1897
CO
363A00000X
Physician Assistant
1897
CO
363A00000X
Physician Assistant
Primary
PA03173
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119732100
—
WY
05
—
200039360A
—
OK
05
—
200267860A
—
KS
05
—
305251601
—
TX
05
—
46883355
—
CO
05
—
66478529
—
NM
01
—
P00231064
RR MEDICARE RIA
CO
Enumeration date
12/22/2005
Last updated
06/04/2013
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