Healthcare Provider Details

I. General information

NPI: 1821446964
Provider Name (Legal Business Name): ALEXANDER THOMAS GIBBONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MUSC DEPARTMENT OF SURGERY 30 COURTENAY DR MSC 295
CHARLESTON SC
29425-0001
US

IV. Provider business mailing address

MUSC DEPARTMENT OF SURGERY 30 COURTENAY DR MSC 295
CHARLESTON SC
29425-0001
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number97237
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: