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General NPI Number Information
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NPI Number | 1275746869
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Entity Type | Individual
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Provider Name | COURTNEY ELIZABETH GIBSON MD
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 333 CEDAR ST YALE MEDICAL SCHOOL
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City | NEW HAVEN
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State | CT
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Zip | 06510-3206
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Country | US
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Telephone | 973-322-5589
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Fax |
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Provider Business Mailing Address
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Address Line | 242 ALDEN AVE
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City | NEW HAVEN
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State | CT
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Zip | 06515-2112
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Country | US
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Telephone | 973-518-0000
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 52029
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License Number State | CT
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