Provider Demographics
NPI:1013335470
Name:GILL, JENNIFER COFFEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:COFFEY
Last Name:GILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:COFFEY GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6100 PAN AMERICAN FREEWAY NE STE 450
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:505-823-8787
Mailing Address - Fax:
Practice Address - Street 1:PRESBYTERIAN HEALTHCARE SERVICES
Practice Address - Street 2:6100 PAN AMERICAN FREEWAY STE 450
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3460
Practice Address - Country:US
Practice Address - Phone:505-823-8787
Practice Address - Fax:505-792-1978
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2018-0691207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14252585OtherCAQH