Provider Demographics
NPI:1093778839
Name:GILBRETH, JANE MARIE (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:MARIE
Last Name:GILBRETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W HOBBS ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-1869
Mailing Address - Country:US
Mailing Address - Phone:505-623-3311
Mailing Address - Fax:505-622-1273
Practice Address - Street 1:111 W HOBBS ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-1869
Practice Address - Country:US
Practice Address - Phone:505-623-3311
Practice Address - Fax:505-622-1273
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99210207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00074557Medicaid
D36909Medicare UPIN