Basic Information
| Provider Information | |||||||||
| NPI: | 1851335376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GIL | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GIL | ||||||||
| OtherFirstName: | WALTER | ||||||||
| OtherMiddleName: | R | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5753 SWLONGSPUR LANE | ||||||||
| Address2: | |||||||||
| City: | PALM CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722605368 | ||||||||
| FaxNumber: | 5617481523 | ||||||||
| Practice Location | |||||||||
| Address1: | 5753 SW LONGSPUR LN | ||||||||
| Address2: | |||||||||
| City: | PALM CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 349908839 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722605368 | ||||||||
| FaxNumber: | 5617481523 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 04/12/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0050565 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 048468700 | 05 | FL | MEDICAID | 07303 | 01 | FL | BLUE CROSS | OTHER |