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NPI Code Detail

MEDICARE: MICHAEL SPENCER GIBSON M.D.

MEDICARE: MICHAEL SPENCER 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
12085B0100XBody Imaging PhysicianD54010MD
22085R0202XDiagnostic Radiology PhysicianC54766CA

General Provider Information

NPI Number : 1447246640
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL SPENCER GIBSON M.D.
Provider Business Mailing Address
First Line : 4060 FAIRMOUNT AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92105-1608
Country : US
Telephone Number : 619-997-4859
Fax Number :
Provider Business Practice Location Address
First Line : 4060 FAIRMOUNT AVE STE 120
Second Line :
City : SAN DIEGO
State : CA
Zip : 92105-1608
Country : US
Telephone Number : 619-269-1299
Fax Number : 619-961-0812
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2005
Last Update Date : 11/14/2022

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