Provider Demographics
NPI:1346426632
Name:GILL FAMILY MEDICINE PL
Entity Type:Organization
Organization Name:GILL FAMILY MEDICINE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-484-1600
Mailing Address - Street 1:425 COMMERCIAL CT STE 112
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-1642
Mailing Address - Country:US
Mailing Address - Phone:941-484-1600
Mailing Address - Fax:941-484-1644
Practice Address - Street 1:425 COMMERCIAL CT STE 112
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1642
Practice Address - Country:US
Practice Address - Phone:941-484-1600
Practice Address - Fax:941-484-1644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG95266Medicare UPIN