MEDICARE: DR. RALPH MILTON GIBSON JR. M.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	207R00000X	Internal Medicine Physician	201346	NY

General Provider Information

NPI Number	:	1972603066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH MILTON GIBSON JR. M.D.

Provider Business Mailing Address
First Line	:	200 PANTIGO PL
Second Line	:	SUITE H
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-5920
Country	:	US
Telephone Number	:	631-324-4700
Fax Number	:	631-324-4748

Provider Business Practice Location Address
First Line	:	200 PANTIGO PL
Second Line	:	SUITE H
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-5920
Country	:	US
Telephone Number	:	631-324-4700
Fax Number	:	631-324-4748

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	07/08/2007

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