Provider Demographics
NPI:1427164334
Name:GILL, WILLIAM JOHN (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:GILL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 CARLTON ST
Mailing Address - Street 2:
Mailing Address - City:WAUCHULA
Mailing Address - State:FL
Mailing Address - Zip Code:33873-3407
Mailing Address - Country:US
Mailing Address - Phone:863-773-6606
Mailing Address - Fax:863-773-9542
Practice Address - Street 1:515 CARLTON ST
Practice Address - Street 2:PIONEER MEDICAL CENTER
Practice Address - City:WAUCHULA
Practice Address - State:FL
Practice Address - Zip Code:33873-3407
Practice Address - Country:US
Practice Address - Phone:863-773-6606
Practice Address - Fax:863-773-9542
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2155363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL290071800Medicaid
FL290071800Medicaid
FLE3797WMedicare UPIN
FLE3797ZMedicare ID - Type Unspecified