Provider Demographics
NPI:1538231774
Name:GILLIS, JOHN MCNATT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MCNATT
Last Name:GILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2211 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4103
Mailing Address - Country:US
Mailing Address - Phone:907-279-8486
Mailing Address - Fax:907-257-8188
Practice Address - Street 1:2211 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4103
Practice Address - Country:US
Practice Address - Phone:907-279-8486
Practice Address - Fax:907-257-8188
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0038231207Q00000X
AK5334207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029246OtherKAISER COMMERCIAL NUMBER
AKMD2989Medicaid
AKBG6573566OtherDEA
AKMD2989Medicaid