Provider Demographics
NPI:1043299704
Name:DILLER, GAYLE LOUISE (DO)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:LOUISE
Last Name:DILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GAYLE
Other - Middle Name:LOUISE
Other - Last Name:DILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1381 SOUTH PATRICK DRIVE
Mailing Address - Street 2:45 MDG/FAMILY HEALTH CLINIC
Mailing Address - City:PAFB
Mailing Address - State:FL
Mailing Address - Zip Code:32925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1381 SOUTH PATRICK DRIVE
Practice Address - Street 2:45 MDG/FAMILY HEALTH CLINIC
Practice Address - City:PAFB
Practice Address - State:FL
Practice Address - Zip Code:32925
Practice Address - Country:US
Practice Address - Phone:321-494-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine