Paul Edwin Gilliam Jr., M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

97-247 Issued in NM

Practice address

2530 S Telshor Blvd
Ste 207
Las Cruces, NM 88011-4951

Phone

(575) 556-6400

Fax

(575) 556-6405

NPI assigned

Nov 22, 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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Raton Colfax Medical Services PC

  • Surgery Physician
  • Plainfield, IL
  • NPI 1598821571
  NPD (past)

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1460419200000",
    "number": "1659354785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6310",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880066310",
            "telephone_number": "575-556-6400",
            "fax_number": "575-556-6405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 S TELSHOR BLVD",
            "address_2": "STE 207",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114951",
            "telephone_number": "575-556-6400",
            "fax_number": "575-556-6405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLIAM",
        "first_name": "PAUL",
        "middle_name": "EDWIN",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NM",
            "license": "97-247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10827331",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00905172",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lilla WD Gilbert, CNP
• Margaret Gilbert
• James Michael Gill, CCSS
• Charles Warren Gillard, LMSW
• Marcey A. Gillespie, MD
• Robert Benton Gilliam Jr.
• Douglas Terry Gillis, DPM
• Ryan Gilmore
• Wesley Gilmore, PA-C
• George Gilson, MD

• Surgery Physician in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Surgery Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; 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.