Provider Demographics
NPI:1578545810
Name:GILFORD, WILLIE L JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIE
Middle Name:L
Last Name:GILFORD
Suffix:JR
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:PO BOX 11407
Mailing Address - Street 2:DRAWER 624
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-0624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1806 SIXTH AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249-0001
Practice Address - Country:US
Practice Address - Phone:205-975-7389
Practice Address - Fax:205-975-4662
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23317207P00000X
ALMD.23317207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1578545810OtherTRICARE SOUTH
AL510-99064OtherBCBS
AL515-41984OtherBCBS
AL051559731Medicaid
AL009938590Medicaid
AL051559731Medicaid
AL051559731Medicare PIN
AL000099064Medicare PIN
AL930103459Medicare PIN
ALP00469426Medicare PIN