Provider Demographics
NPI:1255322988
Name:GILL, GEORGE S (DPM)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:GILL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W HAMPDEN PL
Mailing Address - Street 2:#260
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2470
Mailing Address - Country:US
Mailing Address - Phone:303-761-5454
Mailing Address - Fax:303-339-2525
Practice Address - Street 1:401 W HAMPDEN PL
Practice Address - Street 2:#260
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2470
Practice Address - Country:US
Practice Address - Phone:303-761-5454
Practice Address - Fax:303-339-2525
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00266213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01002666Medicaid
T56423Medicare UPIN
C75414Medicare PIN