Organization
DIANA L. GILLMORE, M.D.,L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANA LEE GILLMORE M.D. (OWNER/SURGEON)
(985) 646-1884
Entity
Organization
Contact information
Practice address
985 ROBERT BLVD, SUITE 103, SLIDELL, LA 70458-2063
(985) 646-1884
(985) 646-1885
Mailing address
985 ROBERT BLVD, SUITE 103, SLIDELL, LA 70458-2063
(985) 646-1884
(985) 646-1885
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
05478R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015875
—
MS
05
—
1363367
—
LA
01
—
39700
BLUE CROSS BLUE SHIELD
LA
Enumeration date
07/26/2011
Last updated
07/26/2011
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