Provider Demographics
NPI:1497831309
Name:SCHMITZ, GILLIAN R (MD)
Entity type:Individual
Prefix:DR
First Name:GILLIAN
Middle Name:R
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34800 BOB WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92134-1098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DRIVE
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7823
Practice Address - Country:US
Practice Address - Phone:210-542-7783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-01511207P00000X
TXM6869207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192645303Medicaid
TX192645301Medicaid
TX8AH275OtherBCBSTX
TX192645302Medicaid
CAFF611YMedicare PIN
TXTXB152869Medicare PIN
CAFF611ZMedicare PIN
TX8F8130Medicare PIN
TX192645303Medicaid