Provider Demographics
NPI:1104018308
Name:CARL VAN GILS, DPM, PC
Entity Type:Organization
Organization Name:CARL VAN GILS, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:VAN GILS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:435-632-6682
Mailing Address - Street 1:31 S REFLECTION WAY
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-8042
Mailing Address - Country:US
Mailing Address - Phone:435-632-6682
Mailing Address - Fax:
Practice Address - Street 1:25 N 300 WEST
Practice Address - Street 2:
Practice Address - City:PANGUITCH
Practice Address - State:UT
Practice Address - Zip Code:84759
Practice Address - Country:US
Practice Address - Phone:435-632-6682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3739380501213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty