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NPI Code Detail

MEDICARE: ZACHARY JOHN GIBSON DO

MEDICARE: ZACHARY JOHN GIBSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207PP0204XPediatric Emergency Medicine (Emergency Medicine) Physician2023-01496NC
22080P0204XPediatric Emergency Medicine (Pediatrics) Physician2023-01496NC
3208000000XPediatrics Physician2023-01496NC

General Provider Information

NPI Number : 1447871710
Entity Type Code : Individual
Provider Name (Legal Business Name) : ZACHARY JOHN GIBSON DO
Provider Business Mailing Address
First Line : PO BOX 19305
Second Line :
City : CHARLOTTE
State : NC
Zip : 28219-9305
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1000 BLYTHE BLVD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28203-5812
Country : US
Telephone Number : 704-355-2171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/28/2020
Last Update Date : 12/29/2025

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