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General NPI Number Information
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NPI Number | 1285828095
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Entity Type | Organization
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Legal Business Name | JAMES A. GIBSON, M.D., P.C.
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 10/27/2010
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Provider Practice Location Address
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Address Line | 5784 HIGHLAND RD
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City | WATERFORD
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State | MI
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Zip | 48327-1876
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Country | US
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Telephone | 248-673-6667
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Fax | 248-673-7224
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Provider Business Mailing Address
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Address Line | 5784 HIGHLAND RD
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City | WATERFORD
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State | MI
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Zip | 48327-1876
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Country | US
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Telephone | 248-673-6667
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Fax | 248-673-7234
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. RENE S GIBSON
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Credential |
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Telephone | 248-431-8592
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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 | 4301065590
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License Number State | MI
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