SCOTT R GILLUM (NPI# 1114003076) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114003076 |
| Entity Type | Individual |
| Full Name | SCOTT R GILLUM |
| Credential | PA |
| Practice Address |
7925 Youree Dr Suite 200 Shreveport LA 71105-5127 |
| Practice Telephone | 3182123610 |
| Practice Fax Number | 3182123672 |
| Mailing Telephone | 3182123610 |
| Mailing Fax Number | 3182123672 |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2014-06-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA200106 | LA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
7925 YOUREE DR SUITE 200 |
| City | SHREVEPORT |
| State | LA |
| Zip Code | 71105-5127 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184610271 | James L Zumbrunnen | Orthopaedic Surgery | 7925 Youree Dr, Suite 200, Shreveport, LA 71105-5127 | 2005-09-23 |
| 1154934974 | Jennifer Fogleman | Specialist/Technologist | 7925 Youree Dr, Shreveport, LA 71105-5127 | 2020-08-31 |
| 1285145706 | Georgia Shively Monk | Physician Assistant | 7925 Youree Dr, Shreveport, LA 71105-5127 | 2017-10-24 |
| 1295038149 | Thea C Pennywell | Physician Assistant | 7925 Youree Dr, Suite 220, Shreveport, LA 71105-5127 | 2010-12-15 |
| 1801128616 | Elise Kayser Kowalewski | Physician Assistant | 7925 Youree Dr, Shreveport, LA 71105-5127 | 2010-02-03 |
| 1881844033 | Georgia M. Baker | Nurse Practitioner | 7925 Youree Dr, Suite 200, Shreveport, LA 71105-5127 | 2008-09-24 |
| 1750558953 | Patrick Massey | Orthopaedic Surgery | 7925 Youree Dr, Suite 200, Shreveport, LA 71105-5127 | 2008-05-15 |
| 1700077294 | Wk Mid South Orthopedics | Orthopaedic Surgery | 7925 Youree Dr, Suite 220, Shreveport, LA 71105-5127 | 2007-08-08 |
| 1164649927 | Diane Renee Mcculler | Registered Nurse | 7925 Youree Dr, Suite 280a, Shreveport, LA 71105-5538 | 2007-04-20 |
| 1417986548 | Cambize Shahrdar Md and Willis-knighton Medical Center | Orthopaedic Surgery | 7925 Youree Dr, Suite 200, Shreveport, LA 71105-5127 | 2006-07-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699245928 | Misty Johnetta Ross | Counselor | 2942 Knight St., Bldg. 4 Suite 426, Shreveport, LA 71105 | 2018-11-29 |
| 1205301868 | Tatjhana Maury | Case Manager/Care Coordinator | 3325 Youree Drive, Shreveport, LA 71105 | 2018-10-10 |
| 1245710920 | Jefferey Douglas Adair Md | Non-Pharmacy Dispensing Site | 8860 Fern Ave., Suite 120, Shreveport, LA 71105 | 2018-08-21 |
| 1679059539 | Michael E Woolbert Dds LLC | Dentist | 7600 Fern Avenue, Building 1100, Shreveport, LA 71105 | 2018-07-13 |
| 1881195675 | Adiba Bibi | Pharmacist | 3555 Greenwood Road, Walgreens, Shreveport, LA 71105 | 2018-02-27 |
| 1740796655 | Allison Borel | Counselor | 2020 E 70th St Ste 201, Shreveport, LA 71105 | 2017-12-15 |
| 1073028148 | Valerie Wooten Barcelona | Physical Therapist | 130 Kayla Street, Shreveport, LA 71105 | 2017-12-11 |
| 1710497615 | Jimmy Carroll | Counselor | 2960 Knight St, Suite 110, Shreveport, LA 71105 | 2017-10-05 |
| 1932618444 | David Louis Bennett | Counselor | 3007 Knight St., Suite 200, Shreveport, LA 71105 | 2017-09-27 |
| 1619496452 | Shaqwana Hodge | Counselor | 2920 Knight St. Suite 110, Shreveport, LA 71105 | 2017-09-13 |
| Find all providers in zip 71105 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285290098 | Nicole Michelle Toups | Physician Assistant | 2551 Greenwood Rd Ste 311, Shreveport, LA 71103-3981 | 2019-05-16 |
| 1235220708 | Maribeth Forrest | Physician Assistant | 2800 Hearne Ave, Shreveport, LA 71103-3934 | 2006-09-27 |
| 1821096686 | Charles Girard Tisdale | Physician Assistant | 1455 E Bert Koun Loop, #210, Shreveport, LA 71105-5634 | 2005-07-14 |
| 1609474428 | Thea Christine Fontenot | Physician Assistant | 2751 Albert L Bicknell Dr Ste 5c, Shreveport, LA 71103-3943 | 2020-10-14 |
| 1285145706 | Georgia Shively Monk | Physician Assistant | 7925 Youree Dr, Shreveport, LA 71105-5127 | 2017-10-24 |
| 1194243899 | Serena Shah Frye | Physician Assistant | 2751 Albert L Bicknell Dr Ste 5c, Shreveport, LA 71103-3943 | 2017-09-01 |
| 1356892665 | Ryan D Elledge | Physician Assistant | 1500 Line Ave, Suite 200, Shreveport, LA 71101-4639 | 2016-10-21 |
| 1104374099 | Britney Brown | Physician Assistant | 2751 Albert L Bicknell Dr, Suite 5c, Shreveport, LA 71103-3920 | 2016-09-20 |
| 1740665694 | Jennifer Michelle Bigbee | Physician Assistant | 2751 Albert L Bicknell Dr, Shreveport, LA 71103-3920 | 2015-07-21 |
| 1356722466 | Surgassist of Shreveport, LLC | Physician Assistant | 949 Olive St, Shreveport, LA 71104-2103 | 2015-06-15 |
| Find all providers in SHREVEPORT | ||||
| City | SHREVEPORT |
| Zip Code | 71105 |
Please comment or provide details below to improve the information on SCOTT R GILLUM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.