Healthcare Provider Details

I. General information

NPI: 1053632091
Provider Name (Legal Business Name): DANIEL R GILBERT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANIEL R GILBERT D.O.

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 E SOUTHERN AVE
MESA AZ
85204-5411
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 480-834-4188
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number34010887
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036.144100
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number34010887
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number20A15720
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number011043
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: