Healthcare Provider Details

I. General information

NPI: 1952966814
Provider Name (Legal Business Name): COLIN DESMOND GIBSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 NEW BERN AVE
RALEIGH NC
27610-1215
US

IV. Provider business mailing address

3000 NEW BERN AVE
RALEIGH NC
27610-1215
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8000
  • Fax: 919-350-8000
Mailing address:
  • Phone: 919-350-8000
  • Fax: 919-350-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number333732
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number73969
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2026-02980
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: