Provider Demographics
NPI:1568728079
Name:GILL, JENNIFER GIBSON
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GIBSON
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UTSW DEPARTMENT OF DERMATOLOGY
Mailing Address - Street 2:5323 HARRY HINES BLVD
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9069
Mailing Address - Country:US
Mailing Address - Phone:214-648-3493
Mailing Address - Fax:214-648-5553
Practice Address - Street 1:UTSW DERMATOLOGY CLINIC
Practice Address - Street 2:5939 HARRY HINES BLVD, 4TH FLOOR, SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390
Practice Address - Country:US
Practice Address - Phone:214-645-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ7554207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology