Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 0101242986 | VA |
NPI | 1003888264 |
---|---|
Provider Name | Carl Anthony Gibson |
First Address | Newport News, VA 23601-1318 |
Second Address | Newport News, VA 23601-2344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 27/11/2013 |