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General NPI Number Information
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NPI Number | 1013909613
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Entity Type | Individual
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Provider Name | PAUL H GIBSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/19/2005
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Last Update Date | 08/30/2016
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Provider Practice Location Address
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Address Line | 11188 TESSON FERRY ROAD SUITE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63123
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Country | US
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Telephone | 314-849-5300
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Fax | 314-849-2014
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Provider Business Mailing Address
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Address Line | 11188 TESSON FERRY RD SUITE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6962
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Country | US
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Telephone | 314-849-5300
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Fax | 314-849-2014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | MDR8115
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License Number State | MO
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