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General NPI Number Information
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NPI Number | 1508001074
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Entity Type | Organization
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Legal Business Name | J SCOTT GIBSON MD PC
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 12/11/2008
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Provider Practice Location Address
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Address Line | 851 NE BAKER ST STE 3
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City | MCMINNVILLE
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State | OR
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Zip | 97128-4991
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Country | US
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Telephone | 503-472-0888
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Fax | 503-434-7246
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Provider Business Mailing Address
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Address Line | 851 NE BAKER ST STE 3
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City | MCMINNVILLE
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State | OR
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Zip | 97128-4991
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Country | US
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Telephone | 503-472-0888
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Fax | 503-434-7246
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Authorized Official
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Title or Position | PRESIDENT
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Name | J SCOTT GIBSON
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Credential | MD
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Telephone | 503-472-0888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD14370
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License Number State | OR
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