Provider Demographics
NPI:1316263163
Name:MOJICA MARTINEZ, GILLIAN SAYRD (MD)
Entity type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:SAYRD
Last Name:MOJICA MARTINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1963
Mailing Address - Country:US
Mailing Address - Phone:612-873-8100
Mailing Address - Fax:
Practice Address - Street 1:2700 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1963
Practice Address - Country:US
Practice Address - Phone:612-873-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine