MEDICARE: RONALD C GIBSON M.D.

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	207R00000X	Internal Medicine Physician	RG052179	MI

General Provider Information

NPI Number	:	1154498525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD C GIBSON M.D.

Provider Business Mailing Address
First Line	:	360 E CHICAGO ST
Second Line	:	SUITE 110
City	:	COLDWATER
State	:	MI
Zip	:	49036-2086
Country	:	US
Telephone Number	:	517-278-7331
Fax Number	:	517-278-9917

Provider Business Practice Location Address
First Line	:	360 E CHICAGO ST
Second Line	:	SUITE 110
City	:	COLDWATER
State	:	MI
Zip	:	49036-2086
Country	:	US
Telephone Number	:	517-278-7331
Fax Number	:	517-278-9917

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/16/2020

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