Provider Demographics
NPI:1295231181
Name:GILBERT, THEODORE JACKSON III
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:JACKSON
Last Name:GILBERT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-3036
Mailing Address - Fax:
Practice Address - Street 1:600 MARY STREET
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47747
Practice Address - Country:US
Practice Address - Phone:812-450-3036
Practice Address - Fax:812-450-2193
Is Sole Proprietor?:No
Enumeration Date:2018-04-01
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.140560207R00000X
390200000X
IN01090911A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program