Individual provider · Type 1 NPI

Scott R. Gillum, PA

Surgical Physician Assistant · Shreveport, LA

NPI number 1114003076 Active

Practice location

7925 Youree Dr, Suite 200
Shreveport, LA 71105-5127

Fax (318) 212-3672

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400XPA200106 (LA)

Surgical Physician Assistant: Definition to come...

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About NPI 1114003076

Scott R. Gillum, PA's National Provider Identifier is 1114003076, issued on Oct 31, 2006. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Shreveport, LA. The record was last updated on Jul 14, 2021.