Healthcare Provider Details

I. General information

NPI: 1285263533
Provider Name (Legal Business Name): MATTHEW MICHAEL GIBBS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 N COLLEGE RD
TWIN FALLS ID
83301-5812
US

IV. Provider business mailing address

190 E BANNOCK ST
BOISE ID
83712-6241
US

V. Phone/Fax

Practice location:
  • Phone: 208-814-5075
  • Fax: 208-933-9660
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1681408
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number011627
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: