Healthcare Provider Details

I. General information

NPI: 1104816297
Provider Name (Legal Business Name): PETER J GILBERT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 04/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 GATEWAY DR
MELBOURNE FL
32901-2607
US

IV. Provider business mailing address

1223 GATEWAY DR
MELBOURNE FL
32901-2607
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-4500
  • Fax: 321-722-3843
Mailing address:
  • Phone: 321-725-4500
  • Fax: 321-722-3843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberME26501
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME26501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: