Provider Demographics
NPI:1104932557
Name:GILBERT, PAUL A (PA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:GILBERT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3170
Mailing Address - Fax:812-235-3330
Practice Address - Street 1:1429 N 6TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-1037
Practice Address - Country:US
Practice Address - Phone:812-242-3170
Practice Address - Fax:812-235-3330
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000149A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000343075OtherANTHEM
970006101OtherRAILROAD MCARE PALAMETTO
INP00844256OtherRAILROAD MEDICARE
IN859930EMedicare PIN
IN000000343075OtherANTHEM
INM400019883Medicare PIN
IN859910A4Medicare PIN
IN607850KMedicare PIN