Provider Demographics
NPI:1962551440
Name:GILL, JAMES BRIAN (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BRIAN
Last Name:GILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13616 CALIFORNIA ST
Mailing Address - Street 2:STE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5335
Mailing Address - Country:US
Mailing Address - Phone:402-496-0404
Mailing Address - Fax:402-496-0517
Practice Address - Street 1:13616 CALIFORNIA ST
Practice Address - Street 2:STE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5335
Practice Address - Country:US
Practice Address - Phone:402-496-0404
Practice Address - Fax:402-496-0517
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4792207X00000X
NC148495207XS0117X
NE24619207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1962551440OtherIA MEDICAID
NE47081304012Medicaid
NE47081304012Medicaid