Provider Demographics
NPI:1356801435
Name:GILL, BENJAMIN D (DO, MBA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:D
Last Name:GILL
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5578 LONGLEY LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1825
Mailing Address - Country:US
Mailing Address - Phone:775-284-8650
Mailing Address - Fax:
Practice Address - Street 1:5578 LONGLEY LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1825
Practice Address - Country:US
Practice Address - Phone:775-284-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-23
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13268767-1204207LP2900X
NE2922208100000X, 208VP0014X
NVCL0724208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation