Healthcare Provider Details

I. General information

NPI: 1174804900
Provider Name (Legal Business Name): PETER JEFFREY GILL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E FLAMINGO RD STE E-120
LAS VEGAS NV
89119-7427
US

IV. Provider business mailing address

1050 E FLAMINGO RD STE E-120
LAS VEGAS NV
89119-7427
US

V. Phone/Fax

Practice location:
  • Phone: 702-733-8098
  • Fax: 702-395-6457
Mailing address:
  • Phone: 702-733-8098
  • Fax: 702-395-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: