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Individual

MARK E GILLESPIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
15640 NEW HAMPSHIRE CT, FORT MYERS, FL 33908-4168
(239) 466-2020
Mailing address
PO BOX 11407, BIRMINGHAM, AL 35246-8575

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
24107
KY
207W00000X
Ophthalmology Physician
Primary
ME148468
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000044961
ANTHEM BCBS
05
0470581032
IL
01
180011413
RAILROAD MEDICARE
01
610706763
TRICARE
05
64241078
KY
05
7100053130
KY
Enumeration date
03/07/2006
Last updated
07/17/2025
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