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General NPI Number Information
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NPI Number | 1225466279
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Entity Type | Individual
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Provider Name | JESSE CLINTON GILES MD
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Gender | Male
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 3705 JOSE TER
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City | JACKSONVILLE
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State | FL
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Zip | 32217-3554
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Country | US
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Telephone | 904-465-6879
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Fax |
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Provider Business Mailing Address
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Address Line | 3705 JOSE TER
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City | JACKSONVILLE
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State | FL
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Zip | 32217-3554
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Country | US
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Telephone |
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Fax |
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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 | 207ZF0201X
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Taxonomy Name | Forensic Pathology Physician
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License Number | ME55714
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME55714
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License Number State | FL
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