Provider Demographics
NPI:1720045842
Name:LEDESMA, GILBERT (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:LEDESMA
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 1:707 N FIELDER RD STE A
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-4637
Mailing Address - Country:US
Mailing Address - Phone:817-277-2671
Mailing Address - Fax:817-460-3004
Practice Address - Street 1:707 N FIELDER RD STE A
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-4637
Practice Address - Country:US
Practice Address - Phone:817-277-2671
Practice Address - Fax:817-460-3004
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8122J0OtherBC/BS
C18242Medicare UPIN
TX8122J0Medicare PIN