MEDICARE: ERI GIBB 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
1	207Q00000X	Family Medicine Physician	OT015791	PA
2	207Q00000X	Family Medicine Physician	DO2264	NV

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	:	1679989420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERI GIBB DO

Provider Business Mailing Address
First Line	:	8379 W SUNSET RD STE 210
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2243
Country	:	US
Telephone Number	:	702-476-2595
Fax Number	:	725-200-3244

Provider Business Practice Location Address
First Line	:	1321 S RAINBOW BLVD STE 101
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-9047
Country	:	US
Telephone Number	:	702-476-2287
Fax Number	:	702-476-2035

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

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	01/25/2023

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Directions to “ ERI GIBB DO” Practice Location

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