Provider Demographics
NPI:1366682999
Name:GILSON, GARY DALE (CST / CFA)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DALE
Last Name:GILSON
Suffix:
Gender:M
Credentials:CST / CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 44TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-3318
Mailing Address - Country:US
Mailing Address - Phone:970-330-3280
Mailing Address - Fax:970-330-3280
Practice Address - Street 1:1902 44TH AVE
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-3318
Practice Address - Country:US
Practice Address - Phone:970-330-3280
Practice Address - Fax:970-330-3280
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-22
Last Update Date:2009-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant