MEDICARE: THOMAS C. GIBBS M.D., P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife	ARNP2208682	FL
2	207VX0000X	Obstetrics Physician	0045800	FL

General Provider Information

NPI Number	:	1033353628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS C. GIBBS M.D., P.A.

Provider Business Mailing Address
First Line	:	820 LUCERNE TER
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3732
Country	:	US
Telephone Number	:	407-648-5101
Fax Number	:	407-648-8464

Provider Business Practice Location Address
First Line	:	820 LUCERNE TER
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32801-3732
Country	:	US
Telephone Number	:	407-648-5101
Fax Number	:	407-648-8464

Authorized Official
Title or Position	:	OWENER
Name	:	DR. THOMAS C. GIBBS
Credential	:	M.D.
Telephone Number	:	407-648-5101

Provider Enumeration Date	:	04/27/2009
Last Update Date	:	04/27/2009

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