# WL GILMER, MD, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669713384
- **Authorized official:** DR. WILLIAM LEWIS GILMER JR. M.D. (PRESIDENT)
- **Authorized official phone:** (386) 256-1212

## Contact information

- **Practice address:** 5111 S RIDGEWOOD AVE, SUITE 104, PORT ORANGE, FL 32127-5170
- **Practice address phone:** (386) 256-1212
- **Mailing address:** 5111 S RIDGEWOOD AVE, SUITE 104, PORT ORANGE, FL 32127-5170
- **Mailing address phone:** (386) 256-1212

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | — | NULL | Yes |
| 207W00000X | Ophthalmology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/05/2013
- **Last updated:** 03/18/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 008424200 | — | FL |