Healthcare Provider Details

I. General information

NPI: 1982802021
Provider Name (Legal Business Name): BRIAN DAVID GIBSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 MOSLEY DR
LYNN HAVEN FL
32444-5625
US

IV. Provider business mailing address

200 DOCTORS DR
PANAMA CITY FL
32405-4559
US

V. Phone/Fax

Practice location:
  • Phone: 850-784-7722
  • Fax:
Mailing address:
  • Phone: 850-784-7722
  • Fax: 850-784-6903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME109350
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: