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General NPI Number Information
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NPI Number | 1689782468
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Entity Type | Individual
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Provider Name | ROBERT JOHN GIBSON MD
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 8101 HINSON FARM RD #118
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3404
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Country | US
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Telephone | 703-360-3008
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Fax | 703-360-6204
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Provider Business Mailing Address
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Address Line | 8101 HINSON FARM RD #118
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City | ALEXANDRIA
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State | VA
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Zip | 22306-3403
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Country | US
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Telephone | 703-360-3008
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Fax | 703-360-6204
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101030484
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License Number State | VA
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