Provider Demographics
NPI:1427219690
Name:GILLMAN, JASON WESLEY (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:WESLEY
Last Name:GILLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 MAIN ST STE 5850
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-7317
Mailing Address - Country:US
Mailing Address - Phone:972-449-0540
Mailing Address - Fax:
Practice Address - Street 1:1717 MAIN ST STE 5850
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-7317
Practice Address - Country:US
Practice Address - Phone:972-449-0540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN4429207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease