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NPI Code Detail

MEDICARE: DANIEL L GIBSON DO

MEDICARE: DANIEL L GIBSON 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
1207Q00000XFamily Medicine Physician2000169649MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
6P00026725OTHERRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1440546366OTHERUNITED HEALTCARE
2174322OTHERBCBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42623345OTHERCIGNA
5534157OTHERHEALTHLINK
7H70166OTHERMERCY
82095433OTHERFIRST HEALTH

General Provider Information

NPI Number : 1699748772
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL L GIBSON DO
Provider Business Mailing Address
First Line : PO BOX 1107
Second Line : HEALTH BRANCH WEST
City : JEFFERSON CITY
State : MO
Zip : 65102-1107
Country : US
Telephone Number : 573-893-7848
Fax Number : 573-893-1984
Provider Business Practice Location Address
First Line : 3308 W EDGEWOOD DR
Second Line : SUITE B
City : JEFFERSON CITY
State : MO
Zip : 65109-6891
Country : US
Telephone Number : 573-893-7848
Fax Number : 573-893-1984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2006
Last Update Date : 06/28/2012

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