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General NPI Number Information
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NPI Number | 1265547533
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Entity Type | Organization
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Legal Business Name | DAVID L. GILBERTSON, DO, PA
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2315 COMO AVE
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City | SAINT PAUL
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State | MN
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Zip | 55108-1723
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Country | US
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Telephone | 651-646-2549
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Fax | 651-646-2480
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Provider Business Mailing Address
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Address Line | 2315 COMO AVE
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City | SAINT PAUL
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State | MN
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Zip | 55108-1723
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Country | US
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Telephone | 651-646-2549
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Fax | 651-646-2480
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID LEE GILBERTSON
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Credential | DO
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Telephone | 651-646-2549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 6251520
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License Number State | MN
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