Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | ME125135 | FL |
NPI | 1326286568 |
---|---|
Provider Name | Dr. Melissa Anne Gibson |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33905-7813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2009 |
Last Update Date | 03/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
105184500 | (05) | FL |