Provider Demographics
NPI:1427389766
Name:GILL, SHAUN DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:DAVID
Last Name:GILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 829641
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-9641
Mailing Address - Country:US
Mailing Address - Phone:215-933-0259
Mailing Address - Fax:215-933-3672
Practice Address - Street 1:595 WEST STATE STREET
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901-5318
Practice Address - Country:US
Practice Address - Phone:215-345-2885
Practice Address - Fax:215-345-2552
Is Sole Proprietor?:No
Enumeration Date:2010-01-27
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2512207R00000X
NE861207R00000X
PAOS018487207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE861OtherNEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES