MEDICARE: R. BARTHOLOMEW GIBBS MD PC

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	174400000X	Specialist	207NSOL35X	TN

General Provider Information

NPI Number	:	1780864074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	R. BARTHOLOMEW GIBBS MD PC

Provider Business Mailing Address
First Line	:	PO BOX 41059
Second Line	:	DBA CENTER FOR DERMATOLOGY
City	:	MEMPHIS
State	:	TN
Zip	:	38174-1059
Country	:	US
Telephone Number	:	901-274-8668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 POPLAR AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38104-7241
Country	:	US
Telephone Number	:	901-274-8668
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	RICHARD GIBBS
Credential	:	M.D.
Telephone Number	:	901-274-8668

Provider Enumeration Date	:	11/05/2007
Last Update Date	:	11/05/2007

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