Provider Demographics
NPI:1306817135
Name:MEJIA, GIL EMMANUEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:GIL EMMANUEL
Middle Name:A
Last Name:MEJIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4102 W LINEBAUGH AVE
Mailing Address - Street 2:SUITE 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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-02-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME73279207RA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256054200Medicaid
FL256054200Medicaid