Provider Demographics
NPI:1669581435
Name:JEFFREY K GILBERTSON MD PA
Entity type:Organization
Organization Name:JEFFREY K GILBERTSON MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:GILBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-549-0039
Mailing Address - Street 1:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450
Mailing Address - Country:US
Mailing Address - Phone:940-549-0039
Mailing Address - Fax:940-549-0073
Practice Address - Street 1:1804 STATE HIGHWAY 16 S
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-4608
Practice Address - Country:US
Practice Address - Phone:940-549-0039
Practice Address - Fax:940-549-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160576801Medicaid
TXH51464Medicare UPIN
TX160576801Medicaid