Provider Demographics
NPI:1730356940
Name:GILL, PAUL S (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:GILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:9200 PINECROFT DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3279
Mailing Address - Country:US
Mailing Address - Phone:281-853-5308
Mailing Address - Fax:281-377-0946
Practice Address - Street 1:9200 PINECROFT DR
Practice Address - Street 2:SUITE 460
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3279
Practice Address - Country:US
Practice Address - Phone:281-853-5308
Practice Address - Fax:281-377-0946
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM86752086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J21AOtherGROUP MEDICARE NUMBER
TX8K9069Medicare PIN