Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 17424 | AL |
N | 2081P2900X | Pain Medicine | 17424 | AL |
NPI | 1013068881 |
---|---|
Provider Name | Dr. Michael G Gibson |
First Address | Hoover, AL 35244-3319 |
Second Address | Hoover, AL 35244-3319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 31/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0510 25521 | BLUECROSSBLUESHIELD AL (01) | AL |
167883900 | US DEPT OF LABOR (01) | |
20-00232 | UNITED HEALTHCARE (01) | AL |
529502690 | (05) | AL |
F63507 | (02) | AL |