Doctor Name: | FRED GILLIAM |
NPI Number: | 1811231525 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | HAS |
License Number: | AS4847 |
Business Practice Address: | 742 N Volusia Ave Orange City, FL - 327634857 |
Business Phone Number: | 3865619496 |
Business Fax Number: | |
Mailing Address: | 5680 Winona Trl, DE LEON SPRINGS |
State: | FL |
Postal Code: | 321303613 |
Phone Number: | 3867171621 |
Fax Number: | |
NPI Enumeration Date: | 11/19/2012 |
NPI Last Update Date: | 03/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | AS4847 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |