Healthcare Provider Details

I. General information

NPI: 1801808589
Provider Name (Legal Business Name): JOHN GIBSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 W WOLFEBORO CT
HERNANDO FL
34442-6448
US

IV. Provider business mailing address

1585 W WOLFEBORO CT
HERNANDO FL
34442-6448
US

V. Phone/Fax

Practice location:
  • Phone: 979-571-0811
  • Fax:
Mailing address:
  • Phone: 979-571-0811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME166736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: