MEDICARE: DR. RYAN GIBB 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	50520	AZ
2	207L00000X	Anesthesiology Physician	9017935-1205	UT
3	208VP0014X	Interventional Pain Medicine Physician	50520	AZ
4	208VP0000X	Pain Medicine Physician	50520	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326366832
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN GIBB M.D.

Provider Business Mailing Address
First Line	:	1425 S HIGLEY RD STE 102
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4798
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 S HIGLEY RD STE 102
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85296-4798
Country	:	US
Telephone Number	:	480-561-5000
Fax Number	:

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

Provider Enumeration Date	:	05/07/2010
Last Update Date	:	06/04/2021

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Directions to “ DR. RYAN GIBB M.D.” Practice Location

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