Provider Demographics
NPI:1578664488
Name:UPCHURCH, GILBERT R (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:R
Last Name:UPCHURCH
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 1:1600 SW ARCHER RD # 100128
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0128
Mailing Address - Country:US
Mailing Address - Phone:352-273-5484
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD # 100128
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0001
Practice Address - Country:US
Practice Address - Phone:352-273-5484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075173208600000X, 2086S0129X
VA01012482142086S0129X
FLME1340142086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4143530Medicaid
FL022772600Medicaid
MIH07326Medicare UPIN
MI0H16092015Medicare PIN