Provider Demographics
NPI:1922659762
Name:GILBERT, ROBERT ERIC (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ERIC
Last Name:GILBERT
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 1:431 E NORTH POCO DR
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-3411
Mailing Address - Country:US
Mailing Address - Phone:435-724-8288
Mailing Address - Fax:
Practice Address - Street 1:431 E NORTH POCO DR
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-3411
Practice Address - Country:US
Practice Address - Phone:435-724-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11452295-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant