Healthcare Provider Details

I. General information

NPI: 1932195567
Provider Name (Legal Business Name): NEIL FRANK GIBBS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34520 BOB WILSON DR DERMATOLOGY DEPARTMENT, NAVAL MEDICAL CENTER
SAN DIEGO CA
92134-2300
US

IV. Provider business mailing address

4747 FINCHLEY TER
SAN DIEGO CA
92130-1336
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-9666
  • Fax: 619-532-9458
Mailing address:
  • Phone: 619-228-5132
  • Fax: 619-532-9458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberG62389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: