Provider Demographics
NPI:1255336350
Name:WALTER R GILBERT JR MD PA
Entity type:Organization
Organization Name:WALTER R GILBERT JR MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:R
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:904-384-2333
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34303Medicare PIN