Individual
GREGORY L. LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
12222 MERIT DR STE 600, DALLAS, TX 75251-3294
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0853
(972) 233-1999
(972) 233-3666
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
J1538
TX
207L00000X
Anesthesiology Physician
Primary
J1538
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00R33Y
BCBS TX
TX
05
—
130511201
—
TX
Enumeration date
08/12/2006
Last updated
07/18/2022
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