Individual
KORY LEE GILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3121 UNIVERSITY DR E STE 100, BRYAN, TX 77802-3499
(979) 776-0169
(979) 776-1372
Mailing address
2900 E 29TH ST, BRYAN, TX 77802-2622
(979) 776-8440
(979) 776-6905
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
M8674
TX
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
M8674
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201122301
—
TX
01
—
8BZ695
BCBS
TX
Enumeration date
06/17/2008
Last updated
07/27/2020
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