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General NPI Number Information
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NPI Number | 1174574255
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Entity Type | Individual
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Provider Name | ROBERT PATRICK GILL M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/13/2006
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 4463 STATE ROUTE 66
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City | MINSTER
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State | OH
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Zip | 45865-8727
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Country | US
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Telephone | 419-394-3387
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Fax | 419-628-9501
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Provider Business Mailing Address
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Address Line | 200 SAINT CLAIR AVE GRAND LAKE PHYSICIAN PRACTICES
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City | SAINT MARYS
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State | OH
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Zip | 45885-2400
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Country | US
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Telephone | 419-394-3387
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Fax | 419-628-4307
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35040370
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License Number State | OH
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