Individual
JACOB R GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014
(540) 981-7000
(540) 981-8429
Mailing address
1906 BELLEVIEW AVE SE, ROANOKE, VA 24014-1838
(540) 981-7000
(540) 981-8429
Taxonomy
Speciality
Code
Description
License number
State
2086S0102X
Surgical Critical Care Physician
Primary
0101264407
VA
390200000X
Student in an Organized Health Care Education/Training Program
4301109915
MI
Other
Enumeration date
03/25/2010
Last updated
08/11/2021
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