Provider Demographics
NPI:1558392779
Name:GIL, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:GIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 ANDREWS HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79703-4817
Mailing Address - Country:US
Mailing Address - Phone:432-686-6605
Mailing Address - Fax:432-682-2284
Practice Address - Street 1:2402 W WALL ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6316
Practice Address - Country:US
Practice Address - Phone:432-688-7700
Practice Address - Fax:432-688-7766
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67825207R00000X
TXM6146207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L22951OtherTX MEDICARE
NJ7P328OtherEMPIRE BCBS
NJ8302103Medicaid
NJ041381DLQMedicare ID - Type UnspecifiedMEDICARE PROV #