Provider Demographics
NPI:1770093619
Name:GILBERT, TRAVIS (PA-C)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:GILBERT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 N 4046 E
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-4952
Mailing Address - Country:US
Mailing Address - Phone:208-252-0960
Mailing Address - Fax:
Practice Address - Street 1:1049 SUMMERS DR
Practice Address - Street 2:
Practice Address - City:REXBURG
Practice Address - State:ID
Practice Address - Zip Code:83440-5335
Practice Address - Country:US
Practice Address - Phone:208-359-4841
Practice Address - Fax:208-359-4842
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant