Individual
MR. LEROY E GILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1600 CENTRAL DR, SUITE 160, BEDFORD, TX 76022-6000
(817) 268-0104
(817) 268-6102
Mailing address
1600 CENTRAL DR, SUITE 160, BEDFORD, TX 76022-6000
(817) 268-0104
(817) 268-6102
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
010720
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
006895499
EEOICP WC
OH
05
—
037214601
—
TX
01
—
180403400
DEPT OF LABOR KENTUCKY
KY
01
—
430042809
RAILROAD MEDICARE
TX
01
—
81179U
BLUE SHIELD OF TEXAS
TX
01
—
CRNA10720
TEXAS WC
TX
Enumeration date
12/13/2006
Last updated
07/12/2012
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