Provider Demographics
NPI:1598198699
Name:HILL, ROY RAY
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:RAY
Last Name:HILL
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 1:1875 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-6248
Mailing Address - Country:US
Mailing Address - Phone:941-505-2358
Mailing Address - Fax:
Practice Address - Street 1:1875 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-6248
Practice Address - Country:US
Practice Address - Phone:941-505-2358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906607305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6906607OtherAHCA LICENSE NUMBER