Individual
MISS JESSICA GILLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4753 BOWSER CT, DALLAS, TX 75219-1513
(214) 914-7118
Mailing address
4753 BOWSER CT, DALLAS, TX 75219-1513
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
30708
OK
207VX0201X
Gynecologic Oncology Physician
2021032827
MO
207VX0201X
Gynecologic Oncology Physician
Primary
V1468
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200100758
—
MO
Enumeration date
06/19/2014
Last updated
10/29/2024
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