Provider Demographics
NPI:1538238118
Name:GILLESPIE, WILLIAM M (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:GILLESPIE
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 1:510 S GRAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-4291
Mailing Address - Country:US
Mailing Address - Phone:626-914-1980
Mailing Address - Fax:626-914-1984
Practice Address - Street 1:510 S GRAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4291
Practice Address - Country:US
Practice Address - Phone:626-914-1980
Practice Address - Fax:626-914-1984
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG812032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G812031Medicaid
CAG81203Medicare ID - Type Unspecified
CA00G812031Medicaid