MEDICARE: GILL FAMILY MEDICINE PL

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	207Q00000X	Family Medicine Physician	OS8937	FL

General Provider Information

NPI Number	:	1346426632
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GILL FAMILY MEDICINE PL

Provider Business Mailing Address
First Line	:	425 COMMERCIAL CT STE 112
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-1642
Country	:	US
Telephone Number	:	941-484-1600
Fax Number	:	941-484-1644

Provider Business Practice Location Address
First Line	:	425 COMMERCIAL CT STE 112
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34292-1642
Country	:	US
Telephone Number	:	941-484-1600
Fax Number	:	941-484-1644

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STACEY GILL
Credential	:	D.O.
Telephone Number	:	941-484-1600

Provider Enumeration Date	:	01/16/2008
Last Update Date	:	05/14/2008

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