Provider Demographics
NPI:1922146224
Name:GELBER, EDWARD LOUIS (PA)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LOUIS
Last Name:GELBER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 N INTERSTATE 35
Mailing Address - Street 2:UNIT 312
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76207-3318
Mailing Address - Country:US
Mailing Address - Phone:972-287-7474
Mailing Address - Fax:972-287-7464
Practice Address - Street 1:116 HALL RD
Practice Address - Street 2:
Practice Address - City:SEAGOVILLE
Practice Address - State:TX
Practice Address - Zip Code:75159-2916
Practice Address - Country:US
Practice Address - Phone:972-287-7474
Practice Address - Fax:972-287-7464
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8Y0104OtherBLUE SHIELD
8G1690Medicare PIN
TXQ15695Medicare UPIN