Provider Demographics
NPI:1225003791
Name:BERDINE, GILBERT G (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:G
Last Name:BERDINE
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:PO BOX 5865
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79408-5865
Mailing Address - Country:US
Mailing Address - Phone:806-743-2898
Mailing Address - Fax:806-743-2787
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-9410
Practice Address - Country:US
Practice Address - Phone:806-743-3150
Practice Address - Fax:806-743-3168
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG6142207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162198100OtherFIRSTCARE
NM10978534Medicaid
TXP00716809OtherRAILROAD MEDICARE
TX133908710Medicaid
NM202035797OtherPRESBYTERIAN COMMERCIAL AND SALUD
TX8CA060OtherBLUE CROSS AND BLUE SHIELD
TX8CA061OtherHMO BLUE
TX8L13449Medicare PIN
NM10978534Medicaid