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General NPI Number Information
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NPI Number | 1770514341
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Entity Type | Individual
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Provider Name | SUSAN HOLLAND GIBSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10,000 BAY PINES BLVD DEPT OF MEDICINE
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City | BAY PINES
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State | FL
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Zip | 33744
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Country | US
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Telephone | 727-398-6661
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Fax | 727-319-1054
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Provider Business Mailing Address
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Address Line | 19810 GULF BLVD #4
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City | INDIAN SHORES
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State | FL
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Zip | 33785-2314
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Country | US
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Telephone | 727-593-3400
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Fax | 727-593-2829
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME0063597
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License Number State | FL
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