David R. Gilliam M.D. Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G36497 Issued in CA

Legal business name

DAVID R. GILLIAM M.D. INC

Practice address

1620 Pennsylvannia Ave
Ste C
Fairfield, CA 94533-3509

Phone

(707) 428-4878

Fax

(707) 428-0806

NPI assigned

Feb 28, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Roy Gilliam, M.D.NPI 1376526236

Title

Owner

Phone

(707) 428-4878

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• David Roy Gilliam, M.D.

  • Family Medicine Physician
  • Fairfield, CA
  • NPI 1376526236
  Authorized official Same address or phone

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558338491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 PENNSYLVANNIA AVE",
            "address_2": "STE C",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333509",
            "telephone_number": "707-428-4878",
            "fax_number": "707-428-0806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 PENNSYLVANNIA AVE",
            "address_2": "STE C",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333509",
            "telephone_number": "707-428-4878",
            "fax_number": "707-428-0806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVID R. GILLIAM M.D. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GILLIAM",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-428-4878",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G36497",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.