Provider Demographics
NPI:1356761373
Name:GILBREATH, PETER CALDWELL (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:CALDWELL
Last Name:GILBREATH
Suffix:
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 1:4900 MUELLER BOULEVARD, SUITE 3S.066C
Mailing Address - Street 2:DELL CHILDREN'S MEDICAL CENTER
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-324-0165
Mailing Address - Fax:
Practice Address - Street 1:4900 MUELLER BOULEVARD, SUITE 3S.066C
Practice Address - Street 2:DELL CHILDREN'S MEDICAL CENTER
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-324-0165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR1532208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP1-0049372OtherBASIC POST GRADUATE TRAINING PERMIT -