Provider Demographics
NPI:1588935332
Name:GILL, GREGORY PAUL (CRNA)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:GILL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX717697367500000X
TXAP121346367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8419ECOtherBCBS
TXP01246284OtherRAIL ROAD
TX294377102Medicaid
TX750818167015OtherTRICARE
TX8335UEOtherBCBS
TX294377101Medicaid
TX294377103Medicaid
TXP01043045OtherRAIL ROAD
TX75-1976930-005OtherTRICARE
TXP01043045OtherRAIL ROAD
TX290413YSE3Medicare PIN