Provider Demographics
NPI:1083641716
Name:SANTOS, GILBERT BRADY (PA)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:BRADY
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 S MCCOLL RD STE B152
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1501
Mailing Address - Country:US
Mailing Address - Phone:956-664-8357
Mailing Address - Fax:956-332-4822
Practice Address - Street 1:208 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2920
Practice Address - Country:US
Practice Address - Phone:956-664-8357
Practice Address - Fax:956-322-4822
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04604363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX28900483Medicaid
TXP01663156OtherRR MEDICARE
TX421545ZLVQOtherMEDICARE
TX8FZ627OtherBCBS