Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 2020-04327 | NC |
N | 207PE0004X | Emergency Medical Services | OS9767 | FL |
NPI | 1205886991 |
---|---|
Provider Name | David Gillis |
First Address | Tampa, FL 33630-3731 |
Second Address | Asheville, NC 28801-4601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 14/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275001500 | (05) | FL |
41677 | BCBS (01) | FL |
I24729 | (02) | FL |