Provider Demographics
NPI:1922035500
Name:STEPHEN B. GILL, M.D.,P.A.
Entity Type:Organization
Organization Name:STEPHEN B. GILL, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-284-2828
Mailing Address - Street 1:3189 HIGHWAY 17 S
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-9371
Mailing Address - Country:US
Mailing Address - Phone:904-284-2828
Mailing Address - Fax:904-284-2810
Practice Address - Street 1:3189 US HIGHWAY 17 S
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-9371
Practice Address - Country:US
Practice Address - Phone:904-284-2828
Practice Address - Fax:904-284-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0037009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL208457OtherAVMED
FL15612OtherBLUE CROSS BLUE SHIELD
FL=========OtherBEECH STREET
FL=========OtherCHAMPVA
FL=========OtherPHCS
FL=========OtherTRICARE FOR LIFE
FL=========OtherCCN
FL=========OtherCLARENDON HEALTHY KIDS
FL=========OtherGREAT WEST
FL=========OtherUNITED HEALTHCARE
FL=========OtherFIRST HEALTH
FL=========OtherAARP
FL15612OtherBLUE CROSS BLUE SHIELD
FL=========OtherAETNA
FL=========OtherCIGNA
FL=========OtherTRICARE FOR LIFE
FL=========OtherGREAT WEST