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General NPI Number Information
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NPI Number | 1801888698
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Entity Type | Individual
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Provider Name | ROBERT J GIBAS PA
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 5050 N CLINTON ST
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City | FORT WAYNE
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State | IN
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Zip | 46825-5886
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Country | US
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Telephone | 260-484-8551
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Fax | 260-482-5060
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Provider Business Mailing Address
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Address Line | 5052 N CLINTON ST
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City | FORT WAYNE
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State | IN
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Zip | 46825-5822
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Country | US
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Telephone | 260-484-8551
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Fax | 260-482-5060
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10000452A
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License Number State | IN
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