Provider Demographics
NPI:1013168004
Name:GILL, WALTUS HUGHES III (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTUS
Middle Name:HUGHES
Last Name:GILL
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:1019 VISTA PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-0278
Mailing Address - Country:US
Mailing Address - Phone:434-200-9009
Mailing Address - Fax:434-200-9005
Practice Address - Street 1:1019 VISTA PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-0278
Practice Address - Country:US
Practice Address - Phone:434-200-9009
Practice Address - Fax:434-200-9005
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2016-08-01
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Provider Licenses
StateLicense IDTaxonomies
VA0101253786207T00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013168004Medicaid
VAVVA531A696Medicare PIN