Provider Demographics
NPI:1174579452
Name:GILLINGHAM, FRANK T (MD)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:T
Last Name:GILLINGHAM
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 1:2550 NORTH HOLLYWOOD WAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-5019
Mailing Address - Country:US
Mailing Address - Phone:818-557-0135
Mailing Address - Fax:818-557-1394
Practice Address - Street 1:15107 VANOWEN STREET
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4597
Practice Address - Country:US
Practice Address - Phone:818-902-2990
Practice Address - Fax:818-904-3793
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37503207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G375030Medicaid
CA00G375030OtherBLUE SHIELD
CA050126CA47117OtherVALLEY PRES TRAILBLAZER
CA00G375030OtherCALOPTIMA
CAG37503OtherBLUE CROSS
CA00G375030OtherBLUE SHIELD
CA00G375030Medicaid