Healthcare Provider Details

I. General information

NPI: 1811177017
Provider Name (Legal Business Name): JEFFREY J GIBSON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MIAMI AVE SUITE 403
MIAMI FL
33133-4236
US

IV. Provider business mailing address

3661 S MIAMI AVE STE 403
MIAMI FL
33133-4230
US

V. Phone/Fax

Practice location:
  • Phone: 305-858-1986
  • Fax: 305-856-3603
Mailing address:
  • Phone: 305-858-1986
  • Fax: 305-856-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME89229
License Number StateFL

VIII. Authorized Official

Name: JEFFREY J GIBSON
Title or Position: PHYSICIAN
Credential: MD
Phone: 305-858-1986