| Mr Ira Richard Gillum, PA C | |
|
104 S Devine, Groveton, TX 75845-0104 | |
| (936) 642-0841 | |
| (936) 642-0849 |
| Full Name | Mr Ira Richard Gillum |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Location | 104 S Devine, Groveton, Texas |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528041951 | NPI | - | NPPES |
| PA 00013 | Other | TX | LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | PA 00013 (Texas) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Ira Richard Gillum, PA C Po Box 459, 104 S Devine, Groveton, TX 75845-0459 Ph: (936) 642-0841 | Mr Ira Richard Gillum, PA C 104 S Devine, Groveton, TX 75845-0104 Ph: (936) 642-0841 |
Mr. Dennis Jay Clark Jr., PA C Physician Assistant Medicare: Medicare Enrolled Practice Location: 110 Magee, Groveton, TX 75845 Phone: 936-642-0841 Fax: 936-642-0849 | |
Keith Edward Jones, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 110 Magee Street, Groveton, TX 75845 Phone: 936-642-0841 Fax: 936-642-0849 |