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General NPI Number Information
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NPI Number | 1508057779
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Entity Type | Organization
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Legal Business Name | WARREN D. GIBSON
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 1629 HIGHWAY 544
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City | CONWAY
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State | SC
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Zip | 29526-8452
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Country | US
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Telephone | 843-347-7281
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Fax | 843-347-9785
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Provider Business Mailing Address
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Address Line | 1629 HIGHWAY 544
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City | CONWAY
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State | SC
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Zip | 29526-8452
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Country | US
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Telephone | 843-347-7281
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Fax | 843-347-9785
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Authorized Official
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Title or Position | PRATITIONER
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Name | MR. WARREN D GIBSON
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Credential |
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Telephone | 843-347-7281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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