Healthcare Provider Details

I. General information

NPI: 1609966266
Provider Name (Legal Business Name): TROY GIBBONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 LEADER AVE OFC 208 DEPT. OF PEDIATRICS, DIVISION OF GASTROENTEROLOGY
LEXINGTON KY
40506-9983
US

IV. Provider business mailing address

138 LEADER AVE OFC 208 DEPT. OF PEDIATRICS, DIVISION OF GASTROENTEROLOGY
LEXINGTON KY
40506-9983
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-1676
  • Fax: 859-257-7799
Mailing address:
  • Phone: 859-218-1676
  • Fax: 859-257-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberE-3162
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number48503
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: