Healthcare Provider Details

I. General information

NPI: 1306817135
Provider Name (Legal Business Name): GIL EMMANUEL A MEJIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 E BEARSS AVE
TAMPA FL
33613-2451
US

IV. Provider business mailing address

1706 E BEARSS AVE
TAMPA FL
33613-2451
US

V. Phone/Fax

Practice location:
  • Phone: 813-960-3436
  • Fax: 813-960-3735
Mailing address:
  • Phone: 813-960-3436
  • Fax: 813-960-3735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME73279
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: