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General NPI Number Information
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NPI Number | 1083706691
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Entity Type | Individual
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Provider Name | MARY E GIBBONS MD
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 375 DIXMYTH AVE
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City | CINCINNATI
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State | OH
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Zip | 45220
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Country | US
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Telephone | 513-872-2432
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Fax | 513-872-8857
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Provider Business Mailing Address
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Address Line | PO BOX 640738
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City | CINCINNATI
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State | OH
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Zip | 45264-0738
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Country | US
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Telephone | 937-293-0247
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Fax | 937-293-0969
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 3588545
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License Number State | OH
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