Healthcare Provider Details

I. General information

NPI: 1679659882
Provider Name (Legal Business Name): MARK W GILCHRIST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 WEST COLONIAL DRIVE SUITE # 390
OCOEE FL
34761
US

IV. Provider business mailing address

10000 WEST COLONIAL DRIVE SUITE # 390
OCOEE FL
34761
US

V. Phone/Fax

Practice location:
  • Phone: 407-290-2394
  • Fax: 407-521-3640
Mailing address:
  • Phone: 407-290-2394
  • Fax: 407-521-3640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME57130
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: