MEDICARE: DR. ROY A. GILL 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	207Q00000X	Family Medicine Physician	TP976	KY
2	207Q00000X	Family Medicine Physician	35.089215	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1548238017	OTHER	NPI

General Provider Information

NPI Number	:	1548238017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY A. GILL M.D.

Provider Business Mailing Address
First Line	:	PO BOX 183103
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43218-3103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 SOUTH HIGH ST.
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43206
Country	:	US
Telephone Number	:	614-293-3330
Fax Number	:	614-293-3336

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	11/18/2008

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