Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | G027526 | CA |
N | 2080A0000X | Adolescent Medicine | G027526 | CA |
NPI | 1043281231 |
---|---|
Provider Name | Dr. Walter Gilbert SR. |
First Address | San Diego, CA 92134-1098 |
Second Address | San Diego, CA 92134-1098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AG8143391 | DEA NUMBER (01) | |
G027526 | MEDICAL LICENSE NUMBER (01) | CA |