Provider Demographics
NPI:1184630774
Name:GILBERT, MARK ALLEN (PA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLEN
Last Name:GILBERT
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 1:212 SAN JOSE ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3928
Mailing Address - Country:US
Mailing Address - Phone:831-649-1000
Mailing Address - Fax:831-649-4962
Practice Address - Street 1:212 SAN JOSE ST STE 301
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3928
Practice Address - Country:US
Practice Address - Phone:831-759-3289
Practice Address - Fax:831-753-5188
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00344363A00000X
CAPA20342363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R54694Medicare UPIN