Healthcare Provider Details

I. General information

NPI: 1255998845
Provider Name (Legal Business Name): GWENDOLYN SUZANNE GILLIES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SW ARCHER RD
GAINESVILLE FL
32608-1134
US

IV. Provider business mailing address

PO BOX 100287
GAINESVILLE FL
32610-0287
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0916
  • Fax: 352-265-3292
Mailing address:
  • Phone: 352-265-0916
  • Fax: 352-265-3292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: