Healthcare Provider Details

I. General information

NPI: 1205886991
Provider Name (Legal Business Name): DAVID GILLIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 BILTMORE AVE
ASHEVILLE NC
28801-4601
US

IV. Provider business mailing address

PO BOX 30731
TAMPA FL
33630-3731
US

V. Phone/Fax

Practice location:
  • Phone: 828-213-1111
  • Fax:
Mailing address:
  • Phone: 800-476-8646
  • Fax: 919-382-3210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2020-04327
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberOS9767
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: