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NPI Code Detail

MEDICARE: DR. RANDALL K GIBB MD

MEDICARE: DR. RANDALL K GIBB 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
1207VX0201XGynecologic Oncology Physician102525MO

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 : 1639195944
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDALL K GIBB MD
Provider Business Mailing Address
First Line : 1031 BELLEVUE AVE STE 400
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63117-1858
Country : US
Telephone Number : 314-977-7455
Fax Number : 314-977-7477
Provider Business Practice Location Address
First Line : 1031 BELLEVUE AVE STE 400
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63117-1858
Country : US
Telephone Number : 314-977-7455
Fax Number : 314-977-7477
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2006
Last Update Date : 05/07/2025

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Directions to “ DR. RANDALL K GIBB MD” Practice Location

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