Healthcare Provider Details

I. General information

NPI: 1356761373
Provider Name (Legal Business Name): PETER CALDWELL GILBREATH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 MUELLER BOULEVARD, SUITE 3S.066C DELL CHILDREN'S MEDICAL CENTER
AUSTIN TX
78723
US

IV. Provider business mailing address

4900 MUELLER BOULEVARD, SUITE 3S.066C DELL CHILDREN'S MEDICAL CENTER
AUSTIN TX
78723
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-0165
  • Fax:
Mailing address:
  • Phone: 512-324-0165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR1532
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: