Provider Demographics
NPI:1083840532
Name:GILBERT, SIDNEY LEE JR (DO)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:LEE
Last Name:GILBERT
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:127 N OAK AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2435
Mailing Address - Country:US
Mailing Address - Phone:931-783-5857
Mailing Address - Fax:931-526-6760
Practice Address - Street 1:1 MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-4294
Practice Address - Country:US
Practice Address - Phone:931-783-2770
Practice Address - Fax:931-525-1176
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2015-05-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN2559208M00000X
VA0102203099207R00000X
TNDO2559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV V6497BMedicare PIN