Provider Demographics
NPI:1730169368
Name:GILBERT, CLYDE CALVIN (CRNA)
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:CALVIN
Last Name:GILBERT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1832
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27216-1832
Mailing Address - Country:US
Mailing Address - Phone:336-585-1770
Mailing Address - Fax:
Practice Address - Street 1:1236 HUFFMAN MILL RD
Practice Address - Street 2:STE 2000
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-585-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC132276163W00000X
NC51257367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051452Medicaid
NC8051452Medicaid