Provider Demographics
NPI:1942795448
Name:GILBERT, MAGDELON (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:MAGDELON
Middle Name:
Last Name:GILBERT
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:MAGDELON
Other - Middle Name:
Other - Last Name:RADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 GORDON COOPER DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74801-9002
Mailing Address - Country:US
Mailing Address - Phone:405-395-9303
Mailing Address - Fax:405-395-9305
Practice Address - Street 1:2345 GORDON COOPER DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-9007
Practice Address - Country:US
Practice Address - Phone:405-395-9303
Practice Address - Fax:405-395-9305
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2280133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered