MEDICARE: WALTER R GILBERT JR MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1255336350
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER R GILBERT JR MD PA

Provider Business Mailing Address
First Line	:	3 SHIRCLIFF WAY
Second Line	:	STE 122
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4757
Country	:	US
Telephone Number	:	904-384-2333
Fax Number	:	904-388-9132

Provider Business Practice Location Address
First Line	:	3 SHIRCLIFF WAY
Second Line	:	STE 122
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4757
Country	:	US
Telephone Number	:	904-384-2333
Fax Number	:	904-388-9132

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WALTER R GILBERT JR.
Credential	:	M.D.
Telephone Number	:	904-384-2333

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	04/18/2008

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