MEDICARE: DR. ROBERT GWYN GIBBY JR. PH.D.

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	103G00000X	Clinical Neuropsychologist	0810000686	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	453076	OTHER	VA	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811077183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GWYN GIBBY JR. PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 478
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-0478
Country	:	US
Telephone Number	:	804-794-8171
Fax Number	:	804-794-3787

Provider Business Practice Location Address
First Line	:	1601 ROLLING HILLS DR
Second Line	:	SUITE 200
City	:	RICHMOND
State	:	VA
Zip	:	23229-5011
Country	:	US
Telephone Number	:	804-249-8302
Fax Number	:

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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