Provider Demographics
NPI:1194961151
Name:GILMER, WILLIAM LEWIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEWIS
Last Name:GILMER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5111 S RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-5169
Mailing Address - Country:US
Mailing Address - Phone:386-256-1212
Mailing Address - Fax:386-256-1213
Practice Address - Street 1:5111 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-5169
Practice Address - Country:US
Practice Address - Phone:386-256-1212
Practice Address - Fax:386-256-1213
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2016-03-18
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Provider Licenses
StateLicense IDTaxonomies
FLME0111581207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008424200Medicaid