Healthcare Provider Details

I. General information

NPI: 1487910238
Provider Name (Legal Business Name): MATTHEW GIBSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 HOSPITAL DR STE 103
SACRAMENTO CA
95823-5408
US

IV. Provider business mailing address

7601 HOSPITAL DR STE 103
SACRAMENTO CA
95823-5408
US

V. Phone/Fax

Practice location:
  • Phone: 916-681-1600
  • Fax:
Mailing address:
  • Phone: 916-681-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA128104
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA128104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: