Shane Gilliam, M.D., P.a.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

L7278 Issued in TX

Legal business name

SHANE GILLIAM, M.D., P.A.

Practice address

630 N Graham Street
Stephenville, TX 76401-3552

Phone

(254) 965-8760

Fax

(254) 965-8766

NPI assigned

Sep 24, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Leslie Shane Gilliam, M.D.

Title

Physician/Owner

Phone

(254) 965-8760

Specialties & licenses 1

Addresses

Other names 1

• Family Medicine Associates of Stephenville Other name

Locations

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

{
    "created_epoch": "1285286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285286400000",
    "number": "1891003802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 N GRAHAM STREET",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764013552",
            "telephone_number": "254-965-8760",
            "fax_number": "254-965-8766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 N GRAHAM STREET",
            "city": "STEPHENVILLE",
            "state": "TX",
            "postal_code": "764013552",
            "telephone_number": "254-965-8760",
            "fax_number": "254-965-8766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHANE GILLIAM, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-24",
        "last_updated": "2010-09-24",
        "status": "A",
        "authorized_official_last_name": "GILLIAM",
        "authorized_official_first_name": "LESLIE",
        "authorized_official_middle_name": "SHANE",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "254-965-8760",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "L7278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Associates of Stephenville",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Heidi Jo Sawyer, RDH
• Dorothy Saxon, R.N. G.N.P.
• Kathy Scott-Marble, LPC ASSOCIATE
• Leigh Ann Scott, PTA
• Select Operations of Stephenville LLC
• Shelley S. Barrett
• Richard Shepherd, M.D.
• Summer Sides, PT
• McKenzie Renee Silvers
• John Steven Simpson, LAT, ATC, CSCS

• Primary Care Clinic/Center in Stephenville, TX
• Providers in Stephenville, TX by specialty
• Primary Care Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; 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.