Provider Demographics
NPI:1225498173
Name:GILBERT, JOHNNY
Entity Type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 BARKER CLODINE RD
Mailing Address - Street 2:APT. 25103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77094-1447
Mailing Address - Country:US
Mailing Address - Phone:713-252-3579
Mailing Address - Fax:
Practice Address - Street 1:529 BARKER CLODINE RD
Practice Address - Street 2:APT. 25103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77094-1447
Practice Address - Country:US
Practice Address - Phone:713-252-3579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2019-08-13
Deactivation Date:2019-08-06
Deactivation Code:
Reactivation Date:2019-08-13
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory