Provider Demographics
NPI:1487620845
Name:CHILES, JOHN GERALD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:GERALD
Last Name:CHILES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6796
Mailing Address - Country:US
Mailing Address - Phone:850-863-8203
Mailing Address - Fax:850-863-8113
Practice Address - Street 1:1005 MAR WALT DRIVE
Practice Address - Street 2:PEDIATRICS
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6796
Practice Address - Country:US
Practice Address - Phone:850-863-8203
Practice Address - Fax:850-863-8113
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME127268208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019796900Medicaid
FLHSZVIOtherBCBSFL