Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 35035801G | OH |
NPI | 1326009945 |
---|---|
Provider Name | Dr. Lawrence L Gibson |
First Address | Mansfield, OH 44906-3418 |
Second Address | Mansfield, OH 44906-3418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0214413 | (05) | OH |
A74355 | (02) |