1275713760 NPI number — DR. SIMON A. L. GIBBS M.D.

Table of content: (NPI 1043914351)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275713760 NPI number — DR. SIMON A. L. GIBBS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBBS
Provider First Name:
SIMON
Provider Middle Name:
A. L.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275713760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 KENNEDY MEMORIAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERVILLE
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04901-4526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-861-3000
Provider Business Mailing Address Fax Number:
207-873-2385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 KENNEDY MEMORIAL DR
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
WATERVILLE
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04901-4540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-861-7874
Provider Business Practice Location Address Fax Number:
207-861-4646
Provider Enumeration Date:
11/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  017545 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3247815 . This is a "U.K. GMC REG #" identifier . This identifiers is of the category "OTHER".




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