Provider Demographics
NPI:1659325280
Name:GAILLARD, PHILIP PORCHER III (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:PORCHER
Last Name:GAILLARD
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8837 GOODBYS EXEC DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217
Mailing Address - Country:US
Mailing Address - Phone:904-731-7650
Mailing Address - Fax:904-448-0370
Practice Address - Street 1:8837 GOODBYS EXEC DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217
Practice Address - Country:US
Practice Address - Phone:904-731-7650
Practice Address - Fax:904-448-0370
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLFL31505207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00709655OtherRAILROAD MEDICARE
FL000521200Medicaid
FL059893300Medicaid
FL000521200Medicaid
FL15437XMedicare PIN
FL059893300Medicaid