Provider Demographics
NPI:1891707857
Name:GILLEON, SPENCER ELWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:ELWOOD
Last Name:GILLEON
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 1:1405 CENTERVILLE RD
Mailing Address - Street 2:SUITE 5400
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4655
Mailing Address - Country:US
Mailing Address - Phone:850-877-0101
Mailing Address - Fax:850-877-2750
Practice Address - Street 1:1405 CENTERVILLE RD
Practice Address - Street 2:SUITE 5400
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4655
Practice Address - Country:US
Practice Address - Phone:850-877-0101
Practice Address - Fax:850-877-2750
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059563207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00459247AMedicaid
FL052136100Medicaid
FL12271OtherBCBS
FL12271OtherBCBS
GA00459247AMedicaid