Provider Demographics
NPI:1801862115
Name:GILBERT, PATRICIA (PA-C/L/ATC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:PA-C/L/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:209 RAMSLAND ST.
Mailing Address - City:BUFFALO
Mailing Address - State:SD
Mailing Address - Zip Code:57720-0182
Mailing Address - Country:US
Mailing Address - Phone:605-375-3999
Mailing Address - Fax:605-375-3998
Practice Address - Street 1:209 RAMSLAND ST.
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:SD
Practice Address - Zip Code:57720-0182
Practice Address - Country:US
Practice Address - Phone:605-375-3999
Practice Address - Fax:605-375-3998
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0529363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6824762Medicaid
SD6824762Medicaid
SDP92922Medicare UPIN