Healthcare Provider Details

I. General information

NPI: 1205839602
Provider Name (Legal Business Name): DALYS M GILLING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12780 RACE TRACK RD STE 205
TAMPA FL
33626-1395
US

IV. Provider business mailing address

PO BOX 10744
CLEARWATER FL
33757-8744
US

V. Phone/Fax

Practice location:
  • Phone: 813-792-8878
  • Fax: 813-443-8171
Mailing address:
  • Phone: 727-532-0002
  • Fax: 727-266-4928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME83352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: