Provider Demographics
NPI:1073710653
Name:GIL EMMANUEL A MEJIA MD PA
Entity Type:Organization
Organization Name:GIL EMMANUEL A MEJIA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA BEECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-960-3436
Mailing Address - Street 1:4102 W LINEBAUGH AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5296
Mailing Address - Country:US
Mailing Address - Phone:813-960-3436
Mailing Address - Fax:813-960-3735
Practice Address - Street 1:4102 W LINEBAUGH AVE
Practice Address - Street 2:STE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5296
Practice Address - Country:US
Practice Address - Phone:813-960-3436
Practice Address - Fax:813-960-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2244015OtherAETNA
FL369744OtherWELLCARE
FLAD169OtherPTAN
FL255428OtherAVMED
FL44247OtherBCBS
FL256054200Medicaid
FL44247OtherBCBS
FLF68431Medicare UPIN