Provider Demographics
NPI:1346277423
Name:HILL, GARY RONALD (DO)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RONALD
Last Name:HILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7471 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1034
Mailing Address - Country:US
Mailing Address - Phone:954-961-9221
Mailing Address - Fax:
Practice Address - Street 1:7471 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-1034
Practice Address - Country:US
Practice Address - Phone:954-961-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8373207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL06665OtherBLUE SHIELD
FL06665OtherBLUE SHIELD
FL06665XMedicare ID - Type Unspecified