Provider Demographics
NPI:1851335376
Name:GIL, WALTER R (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:R
Last Name:GIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WALTER
Other - Middle Name:R
Other - Last Name:GIL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5753 SWLONGSPUR LANE
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990
Mailing Address - Country:US
Mailing Address - Phone:772-260-5368
Mailing Address - Fax:561-748-1523
Practice Address - Street 1:5753 SW LONGSPUR LN
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-8839
Practice Address - Country:US
Practice Address - Phone:772-260-5368
Practice Address - Fax:561-748-1523
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048468700Medicaid
FL07303OtherBLUE CROSS
FL07303CMedicare ID - Type Unspecified
FL048468700Medicaid