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NPI Code Detail

MEDICARE: GARY GILLETTE MD

MEDICARE: GARY GILLETTE 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
1207P00000XEmergency Medicine PhysicianME0079320FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
237752OTHERFLBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528035664
Entity Type Code : Individual
Provider Name (Legal Business Name) : GARY GILLETTE MD
Provider Business Mailing Address
First Line : PO BOX 409036
Second Line :
City : ATLANTA
State : GA
Zip : 30384-9036
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6500 W NEWBERRY RD
Second Line :
City : GAINESVILLE
State : FL
Zip : 32605-4309
Country : US
Telephone Number : 352-333-4900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2006
Last Update Date : 10/25/2010

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