Provider Demographics
NPI:1710951967
Name:HILL, H. LOUIS JR (MD)
Entity Type:Individual
Prefix:
First Name:H.
Middle Name:LOUIS
Last Name:HILL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HENRY
Other - Middle Name:L
Other - Last Name:HILL
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2452 MAHAN DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5377
Mailing Address - Country:US
Mailing Address - Phone:850-877-2126
Mailing Address - Fax:850-878-5190
Practice Address - Street 1:2452 MAHAN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5377
Practice Address - Country:US
Practice Address - Phone:850-877-2126
Practice Address - Fax:850-878-5190
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME26697208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29206OtherBC/BS OF FLORIDA
GA00413531AMedicaid
D85668Medicare UPIN
FL29206OtherBC/BS OF FLORIDA