Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | D64840 | MD |
Y | 208600000X | Surgeon | D64840 | MD |
NPI | 1003822784 |
---|---|
Provider Name | Bruce Robert Gibson |
First Address | Baltimore, MD 21224-2735 |
Second Address | Baltimore, MD 21224-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 06/04/2010 |