Physician Compare National (NPI:1255355079)

HEALTHCARE PROVIDER: CONNIE FRANCIS GIBSTINE M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1255355079
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9830252832
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110919000541
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GIBSTINE
	Individual professional last name
Provider First Name	CONNIE
	Individual professional first name
Provider Middle Name	FRANCIS
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF MISSOURI, COLUMBIA SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	DERMATOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3009 N BALLAS RD B
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 208
	Group Practice or individual's line 2 address
City	ST LOUIS
	Group Practice or individual's city
State	MO
	Group Practice or individual's state
Zip Code	631312323
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y