Provider Demographics
NPI:1316018815
Name:GILBERT, DANIEL R (DO)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:R
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 1:1513 UNION AVE STE 1600
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-9404
Mailing Address - Country:US
Mailing Address - Phone:660-269-8752
Mailing Address - Fax:660-269-8753
Practice Address - Street 1:1513 UNION AVE STE 1600
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9404
Practice Address - Country:US
Practice Address - Phone:660-269-8752
Practice Address - Fax:660-269-8753
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011034568208600000X
IL036101040208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036101040Medicaid
G94973Medicare UPIN