| Entity Name: | STEPHEN B. GILL, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 25 Feb 2000 (25 years ago) |
| Date of dissolution: | 29 Oct 2007 (17 years ago) |
| Last Event: | VOLUNTARY DISS W/ NOTICE |
| Event Date Filed: | 29 Oct 2007 (17 years ago) |
| Document Number: | P00000022050 |
| FEI/EIN Number | 593627973 |
| Address: | 3189 HIGHWAY 17, GREEN COVE SPRINGS, FL, 32043 |
| Mail Address: | 3189 HIGHWAY 17, GREEN COVE SPRINGS, FL, 32043 |
| ZIP code: | 32043 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922035500 | 2006-06-27 | 2020-08-22 | 3189 HIGHWAY 17 S, GREEN COVE SPRINGS, FL, 320439371, US | 3189 US HIGHWAY 17 S, GREEN COVE SPRINGS, FL, 320439371, US | |||||||||||||||||||||||||||||||
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| Phone | +1 904-284-2828 |
| Fax | 9042842810 |
Authorized person
| Name | DR. STEPHEN BOYD GILL |
| Role | PRESIDENT |
| Phone | 9042842828 |
Taxonomy
| Taxonomy Code | 207Q00000X - Family Medicine Physician |
| License Number | ME0037009 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AVMED |
| Number | 208457 |
| State | FL |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 15612 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GILL STEPHEN B | Agent | 1935 LAKESHORE DRIVE N, ORANGE PARK, FL, 32003 |
| Name | Role | Address |
|---|---|---|
| GILL STEPHEN B | President | 1935 LAKESHORE DRIVE N, ORANGE PARK, FL, 32003 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISS W/ NOTICE | 2007-10-29 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2003-04-20 | 3189 HIGHWAY 17, GREEN COVE SPRINGS, FL 32043 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2002-04-20 | 3189 HIGHWAY 17, GREEN COVE SPRINGS, FL 32043 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2002-04-20 | 1935 LAKESHORE DRIVE N, ORANGE PARK, FL 32003 | No data |
| Name | Date |
|---|---|
| CORAPVDWN | 2007-10-29 |
| ANNUAL REPORT | 2007-04-27 |
| ANNUAL REPORT | 2006-04-16 |
| ANNUAL REPORT | 2005-03-27 |
| ANNUAL REPORT | 2004-04-09 |
| ANNUAL REPORT | 2003-04-20 |
| ANNUAL REPORT | 2002-04-20 |
| ANNUAL REPORT | 2001-04-10 |
| Domestic Profit | 2000-02-25 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
