Provider Demographics
NPI:1154345841
Name:GILLESPIE, ALEXANDRA J (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:J
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEANNIE
Other - Middle Name:L
Other - Last Name:GILLESPIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5327 N CENTRAL EXPY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-3361
Mailing Address - Country:US
Mailing Address - Phone:214-219-5880
Mailing Address - Fax:214-219-5881
Practice Address - Street 1:5327 N CENTRAL EXPY
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-3361
Practice Address - Country:US
Practice Address - Phone:214-219-5880
Practice Address - Fax:214-219-5881
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3482207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX220033145OtherMCARE RR
TX220033145OtherMCARE RR
TX00205TMedicare PIN