Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101253786 | VA |
N | 208200000X | Surgeon | 0101253786 | VA |
N | 208600000X | Surgeon | 0101253786 | VA |
NPI | 1013168004 |
---|---|
Provider Name | Dr. Waltus Hughes Gill III |
First Address | Forest, VA 24551-0278 |
Second Address | Forest, VA 24551-0278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 01/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013168004 | (05) | VA |