Individual
THOMAS GILBERT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.R.
Contact information
Practice address
3205 KATIE LYNN DR, CHAMPAIGN, IL 61822-8524
(760) 504-4464
Mailing address
3205 KATIE LYNN DR, CHAMPAIGN, IL 61822-8524
(760) 504-4464
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
193203320-120
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
193203320-120
ORDAINED PASTOR
IL
Enumeration date
08/06/2013
Last updated
08/06/2013
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