Healthcare Provider Details

I. General information

NPI: 1578565370
Provider Name (Legal Business Name): CLYDE E GIBB JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SNOW HILL FAMILY MEDICINE 428 WEST MARKET STREET
SNOW HILL MD
21863
US

IV. Provider business mailing address

100 E CARROLL ST ATTN: PRMG
SALISBURY MD
21801-5422
US

V. Phone/Fax

Practice location:
  • Phone: 410-632-0892
  • Fax: 410-632-2452
Mailing address:
  • Phone: 410-543-7531
  • Fax: 410-912-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0063253
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: