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General NPI Number Information
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NPI Number | 1164869681
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Entity Type | Organization
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Legal Business Name | GEOFFREY J. GIBSON DO PA
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 1501 5TH AVE N
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City | ST PETERSBURG
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State | FL
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Zip | 33705-2008
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Country | US
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Telephone | 727-430-5442
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Fax |
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Provider Business Mailing Address
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Address Line | 7901 SEMINOLE BLVD (1205)
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City | SEMINOLE
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State | FL
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Zip | 33772-4828
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Country | US
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Telephone | 727-430-5433
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GEOFFREY JAMES GIBSON
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Credential | D.O.
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Telephone | 727-430-5433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | OS-0006669
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License Number State | FL
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