Provider Demographics
NPI:1700981271
Name:GILBERT, NATHAN ROGER (DO)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ROGER
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DO
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 634706
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5281
Practice Address - Country:US
Practice Address - Phone:865-471-2500
Practice Address - Fax:865-539-8008
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO1612207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4130976OtherBCBS OF TENNESSEE
TN4130979OtherBCBS OF TENNESSEE
TNP00342823OtherRAILROAD MEDICARE
TN3319856Medicaid
TN3319855Medicaid
TN3319856Medicaid
TN3319856Medicare PIN
TNP00342823OtherRAILROAD MEDICARE