1689636268 NPI number — DR. OLGA GIBBONS M.D.

Table of content: DR. OLGA GIBBONS M.D. (NPI 1689636268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689636268 NPI number — DR. OLGA GIBBONS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GIBBONS
Provider First Name:
OLGA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1689636268
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 UNIVERSITY BLVD STE 104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-2788
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-768-7886
Provider Business Mailing Address Fax Number:
561-627-3991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3385 BURNS RD STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM BEACH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-4328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-768-7886
Provider Business Practice Location Address Fax Number:
561-627-3991
Provider Enumeration Date:
04/06/2006

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: 207Q00000X , with the licence number:  161590 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: ME114917 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 014685500-EFF 4/9/15 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DV3514-P01508770 . This is a "RAILROAD MEDICARE-" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 00930176 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01468550 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 60D241 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com