Shane Gilliam, M.d., P.a.

NPI #1891003802 in Stephenville, Texas

Provider Information

NPI Number: 1891003802
Entity Type: Organization
Organization Name: Shane Gilliam, M.d., P.a.
Primary Specialty: Clinic/Center - Primary Care
Enumeration Date: Sep 24, 2010
Last Updated: Sep 24, 2010

Practice Location

Address: 630 N GRAHAM STREET
City: Stephenville
State: Texas
ZIP Code: 76401-3552
Phone: (254) 965-8760

Authorized Official

Name: DR. LESLIE SHANE GILLIAM, M.D.
Title: PHYSICIAN/OWNER
Phone: (254) 965-8760

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Primary Care — Primary Care	261QP2300X	Primary

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