MEDICARE: LUIS ANDRES GIL DO

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	207RG0100X	Gastroenterology Physician	OS18942	FL
2	207R00000X	Internal Medicine Physician	18942	FL
3	390200000X	Student in an Organized Health Care Education/Training Program

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	:	1104387018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS ANDRES GIL DO

Provider Business Mailing Address
First Line	:	105 PARK PLACE BLVD STE A
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-6870
Country	:	US
Telephone Number	:	863-419-2156
Fax Number	:	863-419-2157

Provider Business Practice Location Address
First Line	:	105 PARK PLACE BLVD STE A
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-6870
Country	:	US
Telephone Number	:	863-419-2156
Fax Number	:	863-419-2157

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

Provider Enumeration Date	:	03/26/2019
Last Update Date	:	01/27/2026

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Directions to “ LUIS ANDRES GIL DO” Practice Location

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