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NPI Code Detail

MEDICARE: DR. NEIL WILLIAM CARLTON GIBSON MD

MEDICARE: DR. NEIL WILLIAM CARLTON GIBSON MD
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
1208C00000XColon & Rectal Surgery PhysicianME141821FL

Other Identifiers

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

General Provider Information

NPI Number : 1467625434
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NEIL WILLIAM CARLTON GIBSON MD
Provider Business Mailing Address
First Line : 11945 SAN JOSE BLVD STE 300
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32223-1627
Country : US
Telephone Number : 904-396-1725
Fax Number : 904-396-4893
Provider Business Practice Location Address
First Line : 4910 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32207-4817
Country : US
Telephone Number : 904-384-1348
Fax Number : 904-384-4406
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2008
Last Update Date : 09/07/2020

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