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General NPI Number Information
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NPI Number | 1790058915
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Entity Type | Individual
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Provider Name | JOSHUA JOSEPH GIBBONS DO
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Gender | Male
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Dates
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Enumeration Date | 02/18/2012
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 340 S WILLARD ST
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4126
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Country | US
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Telephone | 928-649-7991
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Fax | 928-649-7992
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Provider Business Mailing Address
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Address Line | 1200 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3118
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Country | US
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Telephone | 928-213-6235
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Fax | 928-213-6292
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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 | 006904
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 006904
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License Number State | AZ
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