Provider Demographics
NPI:1053773259
Name:GILBERT, RYAN DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:DOUGLAS
Last Name:GILBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:SC
Mailing Address - Zip Code:29536-2503
Mailing Address - Country:US
Mailing Address - Phone:843-774-7336
Mailing Address - Fax:843-667-1362
Practice Address - Street 1:603 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:SC
Practice Address - Zip Code:29536-2503
Practice Address - Country:US
Practice Address - Phone:843-774-7336
Practice Address - Fax:843-777-5572
Is Sole Proprietor?:No
Enumeration Date:2016-03-25
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008754207Q00000X
390200000X
SC87211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program