Provider Demographics
NPI:1386608255
Name:GILMAN, ALEX S (DO)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:S
Last Name:GILMAN
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 1:2610 ALLEN ST
Mailing Address - Street 2:APT 4306
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-8526
Mailing Address - Country:US
Mailing Address - Phone:817-905-5749
Mailing Address - Fax:
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-983-3492
Practice Address - Fax:765-983-7958
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND20080208M00000X
TN2762207R00000X
IN02005177A207R00000X
TXL6911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161326701Medicaid
NC1386608255Medicaid
TNQ014384Medicaid
VA1386608255Medicaid
TX8A9199Medicare PIN
TXH48982Medicare UPIN
NC1386608255Medicaid