Provider Demographics
NPI:1629079017
Name:GILBERT, JERRY H (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:H
Last Name:GILBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 SHOAL CREEK BLVD
Mailing Address - Street 2:SUITE 205N
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1098
Mailing Address - Country:US
Mailing Address - Phone:512-206-4300
Mailing Address - Fax:512-206-4350
Practice Address - Street 1:2410 ROUND ROCK AVE
Practice Address - Street 2:STE. 110
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4003
Practice Address - Country:US
Practice Address - Phone:512-341-0889
Practice Address - Fax:512-341-7147
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2336207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1511925-02Medicaid
H57634Medicare UPIN
TX1511925-02Medicaid
TX8A6395Medicare PIN