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General NPI Number Information
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NPI Number | 1679193056
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Entity Type | Individual
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Provider Name | MICHAEL JAMES GIBSON JUBY DO
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Gender | Male
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Dates
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Enumeration Date | 04/25/2020
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 376 W 10TH AVE
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City | COLUMBUS
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State | OH
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Zip | 43210-1280
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Country | US
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Telephone | 614-366-5130
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Fax |
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Provider Business Mailing Address
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Address Line | 10651 E ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78419-5130
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Country | US
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Telephone | 361-961-6000
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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 | 171000000X
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Taxonomy Name | Military Health Care Provider
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License Number | 0102206811
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 58.034842
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 58.034842
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License Number State | OH
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 0102206811
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License Number State | VA
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