MR. Ira Richard Gillum, PA C

NPI #1528041951 in Groveton, Texas

Provider Information

NPI Number
1528041951
Entity Type
Individual
Name
MR. Ira Richard Gillum, PA C
Gender
Not Specified
Sole Proprietor
Not Answered
Primary Specialty
Physician Assistant
Credential
PA C
Enumeration Date
Nov 21, 2005
Last Updated
Jul 8, 2007

Practice Location

Address
104 S DEVINE
State
Texas
ZIP Code
75845-0104
Phone
(936) 642-0841

Specialties & Taxonomy Codes

Specialty
Physician Assistant

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