Provider Demographics
NPI:1346552064
Name:GILBERT, JEFFREY THOMAS (DIVE IDC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:GILBERT
Suffix:
Gender:M
Credentials:DIVE IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 COLINA DORADO DR
Mailing Address - Street 2:APARTMENT G108
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124
Mailing Address - Country:US
Mailing Address - Phone:619-980-8270
Mailing Address - Fax:
Practice Address - Street 1:3841 COLINA DORADO DR
Practice Address - Street 2:APARTMENT G108
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124
Practice Address - Country:US
Practice Address - Phone:619-980-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians