MEDICARE: DR. WALTUS HUGHES GILL III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	0101253786	VA
2	208600000X	Surgery Physician	0101253786	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013168004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTUS HUGHES GILL III MD

Provider Business Mailing Address
First Line	:	1019 VISTA PARK DR
Second Line	:	SUITE A
City	:	FOREST
State	:	VA
Zip	:	24551-0278
Country	:	US
Telephone Number	:	434-200-9009
Fax Number	:	434-200-9005

Provider Business Practice Location Address
First Line	:	1019 VISTA PARK DR
Second Line	:	SUITE A
City	:	FOREST
State	:	VA
Zip	:	24551-0278
Country	:	US
Telephone Number	:	434-200-9009
Fax Number	:	434-200-9005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	08/01/2016

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