Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 036077426 | IL |
N | 207QA0401X | Family Doctor - Addiction Medicine | 036077426 | IL |
NPI | 1215021100 |
---|---|
Provider Name | Dr. George Carlton Gilbert |
First Address | Peoria, IL 61614-5098 |
Second Address | Peoria, IL 61614-5098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 01/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E41116 | (02) | IL |