Healthcare Provider Details

I. General information

NPI: 1467039883
Provider Name (Legal Business Name): CARLOS J GAIBOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CARLOS JAVIER GAIBOR MD

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PARK ST
BOWLING GREEN KY
42101
US

IV. Provider business mailing address

567 COOKSEY LN APT 5011
BOWLING GREEN KY
42103-9186
US

V. Phone/Fax

Practice location:
  • Phone: 270-780-2770
  • Fax: 270-780-2691
Mailing address:
  • Phone: 929-922-1574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number59771
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: