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NPI Code Detail

MEDICARE: GEORGE V GIBSON JR. DO

MEDICARE: GEORGE V GIBSON JR. DO
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
1207X00000XOrthopaedic Surgery Physician036169353IL
2207X00000XOrthopaedic Surgery Physician5101016496MI

General Provider Information

NPI Number : 1336361559
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE V GIBSON JR. DO
Provider Business Mailing Address
First Line : 1301 S KOKE MILL RD
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-9252
Country : US
Telephone Number : 217-547-9100
Fax Number : 217-547-9236
Provider Business Practice Location Address
First Line : 1301 S KOKE MILL RD
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62711-9252
Country : US
Telephone Number : 217-547-9100
Fax Number : 217-547-9236
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2007
Last Update Date : 04/01/2026

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