Healthcare Provider Details

I. General information

NPI: 1942275268
Provider Name (Legal Business Name): COLVILLE N GIBBS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KEMPSVILLE RD STE 100G
NORFOLK VA
23502
US

IV. Provider business mailing address

850 KEMPSVILLE RD STE 100G
NORFOLK VA
23502
US

V. Phone/Fax

Practice location:
  • Phone: 757-261-5977
  • Fax: 757-275-9913
Mailing address:
  • Phone: 757-261-5977
  • Fax: 757-275-9913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101228414
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: