Provider Demographics
NPI:1225243512
Name:GILGUN, LAWRENCE JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOHN
Last Name:GILGUN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 N DAVIS HWY STE 9C
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6967
Mailing Address - Country:US
Mailing Address - Phone:850-479-7474
Mailing Address - Fax:850-479-8908
Practice Address - Street 1:6160 N DAVIS HWY STE 9C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6967
Practice Address - Country:US
Practice Address - Phone:850-479-7474
Practice Address - Fax:850-479-8908
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0002225103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY0002225OtherPSYCH LICENSE #
FL74344OtherBCBS