Provider Demographics
NPI:1104888460
Name:FIELD, GILBERT ALBERT (DO)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:ALBERT
Last Name:FIELD
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 1:148 13TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-1937
Mailing Address - Country:US
Mailing Address - Phone:812-547-0333
Mailing Address - Fax:812-547-9852
Practice Address - Street 1:109 US HIGHWAY 66 E
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2755
Practice Address - Country:US
Practice Address - Phone:812-547-3447
Practice Address - Fax:812-547-9543
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002941A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200530330Medicaid
IN220620SSSMedicare PIN
IN170090VMedicare PIN
IN200530330Medicaid