Provider Demographics
NPI:1689956906
Name:CEBALLOS, GILDARDO (MD)
Entity Type:Individual
Prefix:
First Name:GILDARDO
Middle Name:
Last Name:CEBALLOS
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 1:4911 SANDHILL DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5320
Mailing Address - Country:US
Mailing Address - Phone:281-239-7870
Mailing Address - Fax:281-633-4985
Practice Address - Street 1:4911 SANDHILL DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5320
Practice Address - Country:US
Practice Address - Phone:281-238-7870
Practice Address - Fax:281-633-4985
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0357207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine