Healthcare Provider Details

I. General information

NPI: 1033353628
Provider Name (Legal Business Name): THOMAS C. GIBBS M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2009
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 LUCERNE TER
ORLANDO FL
32801-3732
US

IV. Provider business mailing address

820 LUCERNE TER
ORLANDO FL
32801-3732
US

V. Phone/Fax

Practice location:
  • Phone: 407-648-5101
  • Fax: 407-648-8464
Mailing address:
  • Phone: 407-648-5101
  • Fax: 407-648-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberARNP2208682
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number0045800
License Number StateFL

VIII. Authorized Official

Name: DR. THOMAS C. GIBBS
Title or Position: OWENER
Credential: M.D.
Phone: 407-648-5101