1386710903 NPI number — DR. GERALD E GIBBS M.D.

Table of content: DR. GERALD E GIBBS M.D. (NPI 1386710903)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386710903 NPI number — DR. GERALD E GIBBS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBBS
Provider First Name:
GERALD
Provider Middle Name:
E
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:
1386710903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
364 SE 8TH AVE
Provider Second Line Business Mailing Address:
SUITE 108-A
Provider Business Mailing Address City Name:
HILLSBORO
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97123-4253
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-640-3687
Provider Business Mailing Address Fax Number:
503-640-3688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
364 SE 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE 108-A
Provider Business Practice Location Address City Name:
HILLSBORO
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97123-4253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-640-3687
Provider Business Practice Location Address Fax Number:
503-640-3688
Provider Enumeration Date:
11/27/2006

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: 207RH0003X , with the licence number:  11852 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: MD11852 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00086741 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 217646 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: R118175 . This is a "MEDICARE #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 83844001 . This is a "BCBS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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