Healthcare Provider Details

I. General information

NPI: 1679151500
Provider Name (Legal Business Name): HANNAH LAMAR GIBSON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

454 SAINT MICHAELS DR STE 200
SANTA FE NM
87505-7602
US

IV. Provider business mailing address

PO BOX 26666
ALBUQUERQUE NM
87125-6666
US

V. Phone/Fax

Practice location:
  • Phone: 505-303-5000
  • Fax:
Mailing address:
  • Phone: 505-303-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO2024-0118
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: