MEDICARE: SHARI LYNN GIBSON 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
1	207Q00000X	Family Medicine Physician	17146	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0252830	OTHER	AZ	BCBS OF ARIZONA
2	2239489	OTHER	AZ	CIGNA HEALTH CARE

General Provider Information

NPI Number	:	1902814916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARI LYNN GIBSON MD

Provider Business Mailing Address
First Line	:	5111 N SCOTTSDALE RD
Second Line	:	SUITE 201
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-7075
Country	:	US
Telephone Number	:	480-656-7654
Fax Number	:	480-656-8718

Provider Business Practice Location Address
First Line	:	5111 N SCOTTSDALE RD
Second Line	:	SUITE 201
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-7075
Country	:	US
Telephone Number	:	480-656-7654
Fax Number	:	480-656-8718

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	06/15/2011

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