Healthcare Provider Details

I. General information

NPI: 1205216579
Provider Name (Legal Business Name): MARY ELIZABETH GIBSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 GLOSTER CREEK VLG STE G1
TUPELO MS
38801-4751
US

IV. Provider business mailing address

499 S GLOSTER ST # G1
TUPELO MS
38801-5539
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-2663
  • Fax:
Mailing address:
  • Phone: 662-377-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number28979
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberU5702
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberTRN21705
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number28979
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: