Provider Demographics
NPI:1265485486
Name:GILBREATH, GREGORY LEE (NP)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:LEE
Last Name:GILBREATH
Suffix:
Gender:M
Credentials:NP
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 419
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77670-0419
Mailing Address - Country:US
Mailing Address - Phone:409-783-1663
Mailing Address - Fax:
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:SUITE P2200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1500
Practice Address - Country:US
Practice Address - Phone:409-892-1192
Practice Address - Fax:409-923-5074
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX250154363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0189219D2Medicaid
TX146592401Medicaid
TX146592401Medicaid
TX00325RMedicare PIN
TXS56426Medicare UPIN