Healthcare Provider Details

I. General information

NPI: 1548764129
Provider Name (Legal Business Name): DILLON MATTHEW GIBSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E 2ND ST STE 400
RENO NV
89502-1198
US

IV. Provider business mailing address

1155 MILL ST # M14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-2400
  • Fax: 775-982-2410
Mailing address:
  • Phone: 775-982-2400
  • Fax: 775-982-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29545
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number29545
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: