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General NPI Number Information
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NPI Number | 1982802021
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Entity Type | Individual
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Provider Name | BRIAN DAVID GIBSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 1303 MOSLEY DR
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City | LYNN HAVEN
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State | FL
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Zip | 32444-5625
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Country | US
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Telephone | 850-784-7722
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Fax |
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Provider Business Mailing Address
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Address Line | 200 DOCTORS DR
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City | PANAMA CITY
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State | FL
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Zip | 32405-4559
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Country | US
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Telephone | 850-784-7722
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Fax | 850-784-6903
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | ME109350
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License Number State | FL
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