Healthcare Provider Details

I. General information

NPI: 1013335470
Provider Name (Legal Business Name): JENNIFER COFFEY GILL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE COFFEY GILL MD

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRESBYTERIAN HEALTHCARE SERVICES 6100 PAN AMERICAN FREEWAY STE 450
ALBUQUERQUE NM
87109-3460
US

IV. Provider business mailing address

6100 PAN AMERICAN FREEWAY NE STE 450
ALBUQUERQUE NM
87109
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8787
  • Fax: 505-792-1978
Mailing address:
  • Phone: 505-823-8787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2018-0691
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: