Basic Information
| Provider Information | |||||||||
| NPI: | 1316018815 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1513 UNION AVE STE 1600 | ||||||||
| Address2: | |||||||||
| City: | MOBERLY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652709404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602698752 | ||||||||
| FaxNumber: | 6602698753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1513 UNION AVE STE 1600 | ||||||||
| Address2: | |||||||||
| City: | MOBERLY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652709404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6602698752 | ||||||||
| FaxNumber: | 6602698753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 09/01/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2011034568 | MO | Y | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 036101040 | IL | N | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036101040 | 05 | IL | MEDICAID |