Provider Demographics
NPI:1821099664
Name:ROEBUCK, GIL PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:GIL
Middle Name:PATRICK
Last Name:ROEBUCK
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 1:4412 SPICEWOOD SPRINGS ROAD
Mailing Address - Street 2:#400
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8500
Mailing Address - Country:US
Mailing Address - Phone:512-459-8429
Mailing Address - Fax:512-459-8429
Practice Address - Street 1:4412 SPICEWOOD SPRINGS ROAD
Practice Address - Street 2:#400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8500
Practice Address - Country:US
Practice Address - Phone:512-459-8429
Practice Address - Fax:512-459-8429
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE4643207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122483404Medicaid
TX122483404Medicaid
TX00A44SMedicare PIN