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General NPI Number Information
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NPI Number | 1447485156
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Entity Type | Organization
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Legal Business Name | HUMBOLDT PHYSICIANS SURGERY AND LASER CENTER LLC
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 3226 TIMBER FALL COURT
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City | EUREKA
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State | CA
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Zip | 95503-4888
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Country | US
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Telephone | 707-443-9777
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Fax | 707-445-1003
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Provider Business Mailing Address
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Address Line | 2840 O'NEIL LANE
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City | EUREKA
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State | CA
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Zip | 95503-4870
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Country | US
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Telephone | 707-443-9777
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Fax | 707-445-1003
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Authorized Official
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Title or Position | 1ST AUTHORIZED OFFICIAL
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Name | DR. GREGORY N GIBB
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Credential | M.D.
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Telephone | 707-443-9777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number |
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License Number State |
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