Healthcare Provider Details

I. General information

NPI: 1790172211
Provider Name (Legal Business Name): MARSHALL GILLETTE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5423 S MCCOLL RD
EDINBURG TX
78539-9183
US

IV. Provider business mailing address

PO BOX 4624
MCALLEN TX
78502-4624
US

V. Phone/Fax

Practice location:
  • Phone: 956-362-7080
  • Fax: 956-362-7094
Mailing address:
  • Phone: 956-362-7080
  • Fax: 956-362-7094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberT2382
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: