Provider Demographics
NPI:1932104197
Name:GILBERT, WALTER R JR (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:R
Last Name:GILBERT
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 SHIRCLIFF WAY
Mailing Address - Street 2:STE 122
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4757
Mailing Address - Country:US
Mailing Address - Phone:904-384-2333
Mailing Address - Fax:904-388-9132
Practice Address - Street 1:3 SHIRCLIFF WAY
Practice Address - Street 2:STE 122
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4757
Practice Address - Country:US
Practice Address - Phone:904-384-2333
Practice Address - Fax:904-388-9132
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMEOO13255207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL209445200Medicaid
FL406182135OtherRAILROAD MEDICARE
FL209445200Medicaid
FL406182135OtherRAILROAD MEDICARE