Healthcare Provider Details

I. General information

NPI: 1649731472
Provider Name (Legal Business Name): WILLIAM JAMES GIBSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 10TH ST N STE 2E
ST PETERSBURG FL
33705-1407
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8206
  • Fax: 727-824-7110
Mailing address:
  • Phone: 727-315-6974
  • Fax: 813-635-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberOS22359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: