MEDICARE: DR. TIMOTHY W 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
1	207X00000X	Orthopaedic Surgery Physician	G70715	CA

General Provider Information

NPI Number	:	1760464242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY W GIBSON MD

Provider Business Mailing Address
First Line	:	19582 BEACH BLVD
Second Line	:	STE 120
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2996
Country	:	US
Telephone Number	:	949-715-7355
Fax Number	:

Provider Business Practice Location Address
First Line	:	17742 BEACH BLVD
Second Line	:	SUITE 245
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6818
Country	:	US
Telephone Number	:	714-848-1911
Fax Number	:	714-841-6761

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	09/21/2016

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