MEDICARE: DR. WILLIAM LEWIS GILMER JR. M.D.

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	207W00000X	Ophthalmology Physician	ME0111581	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194961151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM LEWIS GILMER JR. M.D.

Provider Business Mailing Address
First Line	:	5111 S RIDGEWOOD AVE
Second Line	:	SUITE 104
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-5169
Country	:	US
Telephone Number	:	386-256-1212
Fax Number	:	386-256-1213

Provider Business Practice Location Address
First Line	:	5111 S RIDGEWOOD AVE
Second Line	:	SUITE 104
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-5169
Country	:	US
Telephone Number	:	386-256-1212
Fax Number	:	386-256-1213

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

Provider Enumeration Date	:	12/22/2008
Last Update Date	:	03/18/2016

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