Active NPI
Burgo Doyle Gill III, PA
- Physician Assistant
- Statesville, NC
National Provider Identifier
1881661205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 10193
- Practice address
- 700 Sullivan Rd
Statesville, NC 28677-3440 - Phone
- (704) 924-9111
- NPI assigned
- Mar 3, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10193 | NC | Primary |
Addresses
Primary practice location
700 Sullivan Rd
Statesville, NC 28677-3440
Mailing address
PO Box 1845
Statesville, NC 28687-1845
Phone (704) 873-4277
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10193 | NC | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574380800000",
"number": "1881661205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1845",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286871845",
"telephone_number": "704-873-4277"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 SULLIVAN RD",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "286773440",
"telephone_number": "704-924-9111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILL",
"first_name": "BURGO",
"middle_name": "DOYLE",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-03",
"last_updated": "2019-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NC",
"license": "10193",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Statesville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.