Provider Demographics
NPI:1952564379
Name:GAMILLA, NEIL BRYAN V (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL BRYAN
Middle Name:V
Last Name:GAMILLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8581
Mailing Address - Fax:765-935-1171
Practice Address - Street 1:1471 CHESTER BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1945
Practice Address - Country:US
Practice Address - Phone:765-935-8581
Practice Address - Fax:765-935-1171
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067047A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200958830Medicaid
000000635116OtherANTHEM - RPA
OH0072391Medicaid
000000635116OtherANTHEM - RPA