Healthcare Provider Details

I. General information

NPI: 1821330689
Provider Name (Legal Business Name): JUSTIN JOHN GILBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 10TH ST SE
CEDAR RAPIDS IA
52403
US

IV. Provider business mailing address

202 10TH ST SE
CEDAR RAPIDS IA
52403-2414
US

V. Phone/Fax

Practice location:
  • Phone: 319-247-3010
  • Fax:
Mailing address:
  • Phone: 319-247-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD-45217
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2017-01099
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerNC MEDICAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: