Basic Information
| Provider Information | |||||||||
| NPI: | 1801885827 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GILBERT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 S COWLEY ST | ||||||||
| Address2: | 3RD FLOOR PAIN CLINIC | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992021330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094736159 | ||||||||
| FaxNumber: | 5094736097 | ||||||||
| Practice Location | |||||||||
| Address1: | 711 S COWLEY ST | ||||||||
| Address2: | 3RD FLOOR PAIN CLINIC | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992021330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094736159 | ||||||||
| FaxNumber: | 5094736097 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 103TC0700X | PY 2260 | WA | X | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TH0004X | PY 2260 | WA | X | Behavioral Health & Social Service Providers | Psychologist | Health |
ID Information
| ID | Type | State | Issuer | Description | 205731 | 01 | WA | L&I NUMBER | OTHER |