Basic Information
| Provider Information | |||||||||
| NPI: | 1629079017 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7800 SHOAL CREEK BLVD | ||||||||
| Address2: | SUITE 205N | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787571098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122064300 | ||||||||
| FaxNumber: | 5122064350 | ||||||||
| Practice Location | |||||||||
| Address1: | 2410 ROUND ROCK AVE | ||||||||
| Address2: | STE. 110 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786814003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123410889 | ||||||||
| FaxNumber: | 5123417147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2005 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | K2336 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | K2336 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 1511925-02 | 05 | TX | MEDICAID |