Provider Demographics
NPI:1134487242
Name:GILBRIDE, GEORGE WARREN (RPA)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:WARREN
Last Name:GILBRIDE
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600SW ARCHER ROAD
Mailing Address - Street 2:DEPARTMENT FO RADIOLOGY
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0374
Mailing Address - Country:US
Mailing Address - Phone:352-265-0116
Mailing Address - Fax:352-265-0067
Practice Address - Street 1:1600 SW ARCHER ROAD
Practice Address - Street 2:DEPARTMENT FO RADIOLOGY
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0374
Practice Address - Country:US
Practice Address - Phone:352-265-0116
Practice Address - Fax:352-265-0067
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRA 26243U00000X
FLCRT 24366247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist