MEDICARE: DR. LAWRENCE G GILL III M.D.

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	174400000X	Specialist	3578A	WY
2	207V00000X	Obstetrics & Gynecology Physician	3578A	WY

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	3578A	OTHER	WY	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1780667808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE G GILL III M.D.

Provider Business Mailing Address
First Line	:	1333 W. 5TH ST, STE 110
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-2752
Country	:	US
Telephone Number	:	307-672-2522
Fax Number	:	307-672-3732

Provider Business Practice Location Address
First Line	:	1333 W 5TH ST, STE 210
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-2752
Country	:	US
Telephone Number	:	307-672-2522
Fax Number	:	307-672-3732

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	03/07/2023

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