Healthcare Provider Details

I. General information

NPI: 1033629183
Provider Name (Legal Business Name): CLAUDIA J GIBBONS MHS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLAUDIA J GIBBONS

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 10467
GREENSBORO NC
27404-0467
US

IV. Provider business mailing address

100 STRATFORD LAKES DR UNIT 227
DURHAM NC
27713-3480
US

V. Phone/Fax

Practice location:
  • Phone: 336-207-7005
  • Fax:
Mailing address:
  • Phone: 860-817-7414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0010-07629
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: