MEDICARE: MARK E GILLESPIE MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	ME148468	FL
2	207W00000X	Ophthalmology Physician	24107	KY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180011413	OTHER		RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	610706763	OTHER	TRICARE
5	000000044961	OTHER	ANTHEM BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1942277280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK E GILLESPIE MD

Provider Business Mailing Address
First Line	:	PO BOX 11407
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35246-8575
Country	:	US
Telephone Number	:	864-359-1308
Fax Number	:	239-496-3939

Provider Business Practice Location Address
First Line	:	15640 NEW HAMPSHIRE CT
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33908-4168
Country	:	US
Telephone Number	:	239-466-2020
Fax Number	:

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	06/02/2026

15640 NEW HAMPSHIRE CT
FORT MYERS, FL
33908-4168

Practice Phone: 239-466-3111
Practice Fax: 239-466-9499