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DR. DALE GILLAN MD

>> Surgery >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1578543617

Individual Registrant:
DR. DALE  GILLAN MD
Gender: M
Not Sole Proprietor

Location and contact information for practice:
23450 US HIGHWAY 160  WALSENBURG, CO 81089-9104 US
Tel: 719-738-4588  Fax: 719-738-4534

Contact information for business:
23500 US HIGHWAY 160  WALSENBURG, CO 81089-9524 US
Tel: 719-738-5100  Fax: 719-738-5138

Registration Information:
NPI: 1578543617
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N208600000XAllopathic & Osteopathic Physicians
Surgery
AZ33569
N208600000XAllopathic & Osteopathic Physicians
Surgery
NMMD2012-0389
Y208600000XAllopathic & Osteopathic Physicians
Surgery
CO53050

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
911190AZ05




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