MEDICARE: COLIN DESMOND GIBSON M.D.

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	207L00000X	Anesthesiology Physician	333732	NY
2	207L00000X	Anesthesiology Physician	73969	CT
3	207L00000X	Anesthesiology Physician	2026-02980	NC

General Provider Information

NPI Number	:	1952966814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLIN DESMOND GIBSON M.D.

Provider Business Mailing Address
First Line	:	3000 NEW BERN AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1215
Country	:	US
Telephone Number	:	919-350-8000
Fax Number	:	919-350-8000

Provider Business Practice Location Address
First Line	:	3000 NEW BERN AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-1215
Country	:	US
Telephone Number	:	919-350-8000
Fax Number	:	919-350-8000

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

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	06/01/2026

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