Provider Demographics
NPI:1831110964
Name:THOMAS D GILBERTS MD LLC
Entity Type:Organization
Organization Name:THOMAS D GILBERTS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:GILBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-614-8400
Mailing Address - Street 1:17200 NW CORRIDOR CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3295
Mailing Address - Country:US
Mailing Address - Phone:503-614-8400
Mailing Address - Fax:
Practice Address - Street 1:17200 NW CORRIDOR CT
Practice Address - Street 2:SUITE 105
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3295
Practice Address - Country:US
Practice Address - Phone:503-614-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227035Medicaid
ORH86555Medicare UPIN
OR227035Medicaid