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General NPI Number Information
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NPI Number | 1336142124
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Entity Type | Individual
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Provider Name | PATRICK JOHN GIBBONS M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2005
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Last Update Date | 08/31/2007
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Provider Practice Location Address
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Address Line | 13700 ST FRANCIS BLVD SUITE 500
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-3222
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Country | US
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Telephone | 804-378-7443
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Fax | 804-378-0744
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Provider Business Mailing Address
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Address Line | PO BOX 8310
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City | ROANOKE
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State | VA
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Zip | 24014-0310
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Country | US
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Telephone | 540-345-3556
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Fax | 540-342-2193
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101229755
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License Number State | VA
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