Healthcare Provider Details

I. General information

NPI: 1720032014
Provider Name (Legal Business Name): KEITH A GILBERT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W ARKANSAS LN
ARLINGTON TX
76013-6308
US

IV. Provider business mailing address

200 W MAGNOLIA AVE STE 201
FORT WORTH TX
76104-7657
US

V. Phone/Fax

Practice location:
  • Phone: 817-702-1100
  • Fax:
Mailing address:
  • Phone: 817-702-2977
  • Fax: 817-702-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA06490
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: