Healthcare Provider Details

I. General information

NPI: 1215021100
Provider Name (Legal Business Name): GEORGE CARLTON GILBERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 N UNIVERSITY ST
PEORIA IL
61604-1324
US

IV. Provider business mailing address

PO BOX 9727
PEORIA IL
61612-9727
US

V. Phone/Fax

Practice location:
  • Phone: 309-886-9172
  • Fax: 309-509-4045
Mailing address:
  • Phone: 309-886-9172
  • Fax: 309-509-4045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036077426
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number036077426
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: