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NPI Code Detail

MEDICARE: BREEANNA DANIELA GIBSON MD

MEDICARE: BREEANNA DANIELA GIBSON MD
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
1207V00000XObstetrics & Gynecology Physician26365OK

General Provider Information

NPI Number : 1588824635
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREEANNA DANIELA GIBSON MD
Provider Business Mailing Address
First Line : 920 STANTON L YOUNG BLVD # 2410
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-5020
Country : US
Telephone Number : 405-271-8787
Fax Number :
Provider Business Practice Location Address
First Line : 920 STANTON L YOUNG BLVD # 2410
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73104-5020
Country : US
Telephone Number : 405-271-8787
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2008
Last Update Date : 06/12/2008

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