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General NPI Number Information
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NPI Number | 1124625801
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Entity Type | Organization
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Legal Business Name | GIBSON MEDICAL PA
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Dates
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Enumeration Date | 10/06/2020
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Last Update Date | 10/06/2020
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Provider Practice Location Address
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Address Line | 307 ALCAZAR ST
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City | ST AUGUSTINE
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State | FL
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Zip | 32080-3708
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Country | US
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Telephone | 904-495-5269
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3123
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-3123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY GIBSON
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Credential | MD
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Telephone | 904-495-5269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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