Provider Demographics
NPI:1568499929
Name:MOUSER, GILBERT W (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:W
Last Name:MOUSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:219 GRANT UTLEY AVE
Mailing Address - City:CASS LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56633-0067
Mailing Address - Country:US
Mailing Address - Phone:218-335-2559
Mailing Address - Fax:218-335-2755
Practice Address - Street 1:219 GRANT UTLEY AVE
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633-0067
Practice Address - Country:US
Practice Address - Phone:218-335-2559
Practice Address - Fax:218-335-2755
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN21626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D75634Medicare UPIN