Ira Richard Gillum, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 00013 Issued in TX

Practice address

104 S Devine
Groveton, TX 75845-0104

Phone

(936) 642-0841

Fax

(936) 642-0849

NPI assigned

Nov 21, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• D & F Med, PLLC

  • Rural Health Clinic/Center
  • Groveton, TX
  • NPI 1114149671
  NPD (past)
• D & F Med, PLLC

  • Rural Health Clinic/Center
  • Greenville, TX
  • NPI 1124905666
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1528041951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 459",
            "address_2": "104 S DEVINE",
            "city": "GROVETON",
            "state": "TX",
            "postal_code": "758450459",
            "telephone_number": "936-642-0841",
            "fax_number": "936-642-0849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S DEVINE",
            "city": "GROVETON",
            "state": "TX",
            "postal_code": "758450104",
            "telephone_number": "936-642-0841",
            "fax_number": "936-642-0849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLUM",
        "first_name": "IRA",
        "middle_name": "RICHARD",
        "name_prefix": "Mr.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA 00013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA 00013",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• D & F Med, PLLC
• D&F Med, PLLC
• Cecilia Dixon, FNP-C
• Lyndsey Kay Driskell, M.S. CCC-SLP
• Connie Dee Fuller
• Laura Lea Glover, LVN
• Golden Pond Counseling
• Groveton Emergency Medical Service Inc
• Groveton I Enterprises LLC
• Groveton I Enterprises, LLC

• Physician Assistant in Groveton, TX
• Providers in Groveton, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.