Provider Demographics
NPI:1740444348
Name:GILGORE, GARY S (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:GILGORE
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 1:585 EAGLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-8020
Mailing Address - Country:US
Mailing Address - Phone:239-732-6540
Mailing Address - Fax:
Practice Address - Street 1:585 EAGLE CREEK DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-8020
Practice Address - Country:US
Practice Address - Phone:239-732-6540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD010409E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist