Healthcare Provider Details

I. General information

NPI: 1063435303
Provider Name (Legal Business Name): ROBERT LEE GILBERT CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5150 JOURNAL CENTER BLVD NE
ALBUQUERQUE NM
87109-5900
US

IV. Provider business mailing address

PO BOX 26028
ALBUQUERQUE NM
87125-6028
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-3233
  • Fax: 505-262-3191
Mailing address:
  • Phone: 505-262-7963
  • Fax: 505-232-1627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR19189
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR19189
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: