Provider Demographics
NPI:1508879123
Name:GILL, HOWARD S
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:S
Last Name:GILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-3737
Mailing Address - Country:US
Mailing Address - Phone:954-351-5840
Mailing Address - Fax:954-351-5739
Practice Address - Street 1:1900 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-3737
Practice Address - Country:US
Practice Address - Phone:954-351-5840
Practice Address - Fax:954-351-5739
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME584022080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055385900Medicaid
FL11994ZMedicare ID - Type Unspecified
FL055385900Medicaid