MEDICARE: DAVID KURT 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	2084P0800X	Psychiatry Physician	A91905	CA
2	2084P0800X	Psychiatry Physician	MD13524	HI
3	2084P0800X	Psychiatry Physician	13253	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942398383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID KURT GIBSON MD

Provider Business Mailing Address
First Line	:	304 S JONES BLVD STE 5729
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89107-2623
Country	:	US
Telephone Number	:	608-387-1819
Fax Number	:

Provider Business Practice Location Address
First Line	:	9500 HILLWOOD DR STE 140
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89134-0525
Country	:	US
Telephone Number	:	725-235-7884
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	11/18/2023

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