Provider Demographics
NPI:1548290711
Name:GILBREATH, ERIC C (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
Last Name:GILBREATH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:413 ALLUMBAUGH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9212
Mailing Address - Country:US
Mailing Address - Phone:208-323-1125
Mailing Address - Fax:208-323-9604
Practice Address - Street 1:413 ALLUMBAUGH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9212
Practice Address - Country:US
Practice Address - Phone:208-323-1125
Practice Address - Fax:208-323-9604
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2017-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IDM87402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1109578Medicare PIN
G58888Medicare UPIN
ID1109578Medicare PIN