Provider Demographics
NPI:1366037608
Name:GILBERT, JOHN ALLEN
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ALLEN
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 1:510 S. BERNARD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204
Mailing Address - Country:US
Mailing Address - Phone:360-202-0725
Mailing Address - Fax:
Practice Address - Street 1:501 S BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2511
Practice Address - Country:US
Practice Address - Phone:360-202-0725
Practice Address - Fax:509-323-1607
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1003150OtherCOMMISION ON DIETIC REGISTRATION