MEDICARE: GAYLE LOUISE DILLER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS012475	PA

General Provider Information

NPI Number	:	1043299704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE LOUISE DILLER D.O.

Provider Business Mailing Address
First Line	:	1381 SOUTH PATRICK DRIVE
Second Line	:	45 MDG/FAMILY HEALTH CLINIC
City	:	PAFB
State	:	FL
Zip	:	32925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1381 SOUTH PATRICK DRIVE
Second Line	:	45 MDG/FAMILY HEALTH CLINIC
City	:	PAFB
State	:	FL
Zip	:	32925
Country	:	US
Telephone Number	:	321-494-1146
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	09/02/2011

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