DR. RODNEY GILLMAN JAY JR.


Address: 450 E Main St, Rexburg, ID 83440-2048
Phone: 2083563691

DR. RODNEY GILLMAN JAY JR. (NPI# 1225201148) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1225201148
Entity Type Individual
Full Name DR. RODNEY GILLMAN JAY JR.
Credential MD
Practice Address 450 E Main St
Rexburg
ID 83440-2048
Practice Telephone 2083563691
Mailing Telephone 2083563691
Enumeration Date 2008-04-11
Last Update Date 2020-04-13
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207PE0004X Emergency Medicine
Specialization: Emergency Medical Services
M-12527 ID Allopathic & Osteopathic Physicians
N 207PE0004X Emergency Medicine
Specialization: Emergency Medical Services
5298339-1205 UT Allopathic & Osteopathic Physicians
N 207PS0010X Emergency Medicine
Specialization: Sports Medicine
5298339-1205 UT Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
UT 1225201148 05

Provider Secondary Practice Location

Address Telephone Number Fax Number
50 N Medical Dr, Salt Lake City, UT 841320001 8015812292

Office Location

Street Address 450 E MAIN ST
City REXBURG
State ID
Zip Code 83440-2048

Providers in the same location

NPI Name Taxonomy Address Enumeration
1639111206 Madison Physician Services Emergency Medicine 450 E Main St, Rexburg, ID 83440-2048 2006-06-11
1396352142 Karissa Thueson Nurse Practitioner 450 E Main St, Rexburg, ID 83440-2048 2020-09-25
1376192674 David Howard Anderson Pharmacist 450 E Main St, Rexburg, ID 83440-2048 2019-09-09
1124676663 Susan B Clark Dietitian, Registered 450 E Main St, Rexburg, ID 83440-2048 2019-08-28
1790278760 Allen Terry Miller Pharmacist 450 E Main St, Rexburg, ID 83440-2048 2018-06-13
1831682194 Dorsie Thomas Sullenger Pharmacist 450 E Main St, Rexburg, ID 83440-2048 2018-06-12
1184122756 Steven Craig Pierce Physician Assistant 450 E Main St, Rexburg, ID 83440-2048 2018-01-29
1215471065 Troy Hanson Nurse Practitioner 450 E Main St, Rexburg, ID 83440-2048 2016-12-13
1346692605 University of Utah Pediatric Services Pediatrics 450 E Main St, Rexburg, ID 83440-2048 2016-07-11
1871941724 Justin Shippen Family Medicine 450 E Main St, Rexburg, ID 83440-2048 2016-06-01
Find all providers in the same location

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1235768490 Henry's Fork Surgery Center Pllc Clinic/Center 23 Sawtelle Ave, Rexburg, ID 83440 2020-04-08
1952956906 Shane Ellis Withers Pharmacist 164 E. Main, Rexburg, ID 83440 2019-08-06
1316392285 Emma Anderson Speech-Language Pathologist 36 Professional Plaza Suite 110, Rexburg, ID 83440 2016-04-28
1851755524 Sandra Frickey Speech-Language Pathologist 1087 Summers Drive, Premier Therapy Associates, Rexburg, ID 83440 2016-04-08
1275997215 Kerry Denney Counselor 333 Walker Drive, Rexburg, ID 83440 2016-04-06
1467837583 Wal-mart Stores, Inc. Technician/Technologist 303 E Moody Rd, Rexburg, ID 83440 2015-07-30
1649692609 Tanabell Health Services, Inc. Skilled Nursing Facility 410 W 1st N, Rexburg, ID 83440 2014-01-10
1043652571 Creed Simon Webster Counselor 30 S 2nd W, Rexburg, ID 83440 2013-07-25
1033461660 James Cannon Allen Dds PC Dentist 106 E 1st North, Rexburg, ID 83440 2012-10-05
1417217316 Shelby Dee Woolstenhulme Speech-Language Pathologist 450 E. Main Street, Rexburg, ID 83440 2012-05-24
Find all providers in zip 83440

Taxonomy Information

Taxonomy Code 207PE0004X
Grouping Allopathic & Osteopathic Physicians
Classification Emergency Medicine
Specialization Emergency Medical Services

Taxonomy Definition

An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients.
Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1194019406 Michael Anderson Emergency Medicine 450 E Main St, Rexburg, ID 83440-2048 2011-06-03

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1538516471 Anthony Christopher Derrico Emergency Medicine 366 Gunfighter Ave Ste 498, Mountain Home Afb, ID 83648-5258 2016-05-20
1881752913 Richard K Thurston Emergency Medicine 229 S 7th Street, St Maries, ID 83861 2006-12-04
1255399820 Warren William Gude Emergency Medicine 600 Robbins Road, The Center for Wound Healing and Hyperbaric Medicine, Boise, ID 83702 2006-05-03
1821529918 Jonathan Subaitani Emergency Medicine 11197 W Fairview Ave, Boise, ID 83713 2017-03-21
1841679669 Robert John Hagenberg IIi Emergency Medicine 3080 E Gentry Way Ste 210, Meridian, ID 83642 2015-05-26
1508003104 Rocky Mountain Emergency Physicians, LLC Emergency Medicine 777 Hospital Way, Pocatello, ID 83201 2009-01-19
1720114275 North Idaho Immediate Care Emergency Medicine 750 N Syringa St, Suite 100, Post Falls, ID 83854-5275 2007-02-26
1407903669 Debra K Mckinnon Emergency Medicine 700 S Main St, Moscow, ID 83843-3056 2007-01-03
1710034988 Kurt R Martyn Emergency Medicine 700 S Main St, Moscow, ID 83843-3056 2007-01-03
1235216706 John Kenneth Dudek Emergency Medicine 500 W Fort St, Medical Services, Boise, ID 83702-4501 2006-11-01
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Competitor

Search similar providers

City REXBURG
Zip Code 83440

Improve Information

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Dataset Information

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.

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