Individual
DIRCK ANTHONY GILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
145 ELK PL, NEW ORLEANS, LA 70112-2645
(504) 525-0918
Mailing address
2401 DIVISION ST APT E34, METAIRIE, LA 70001-8805
(504) 975-7102
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
045476
LA
Other
Enumeration date
07/14/2011
Last updated
07/15/2011
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