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General NPI Number Information
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NPI Number | 1407053036
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Entity Type | Individual
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Provider Name | VANESSA R GIBSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 1265 UNION AVE, 2 SHORB TOWER
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City | MEMPHIS
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State | TN
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Zip | 38104
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Country | US
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Telephone | 901-478-2211
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Fax | 901-478-2215
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Provider Business Mailing Address
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Address Line | 1211 UNION AVE STE 330 C/O PROVIDER ENROLLMENT
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City | MEMPHIS
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State | TN
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Zip | 38104-6655
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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 |
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 262935-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 39734
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 72174
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License Number State | TN
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