Provider Demographics
NPI:1962559070
Name:GILMOUR, IAN JAMES (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:JAMES
Last Name:GILMOUR
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 1:14342 BROOKS KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-0200
Mailing Address - Country:US
Mailing Address - Phone:704-845-0420
Mailing Address - Fax:
Practice Address - Street 1:14342 BROOKS KNOLL LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-0200
Practice Address - Country:US
Practice Address - Phone:704-845-0420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22154207L00000X
VA0101056981207L00000X
SD3841207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology