Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207NS0135X | Procedural Dermatology | 06637 | MS |
Y | 207NS0135X | Procedural Dermatology | 7152 | TN |
N | 207NS0135X | Procedural Dermatology | R-4673 | AR |
NPI | 1306937891 |
---|---|
Provider Name | Dr. Richard Bartholomew Gibbs |
First Address | Memphis, TN 38104-7241 |
Second Address | Memphis, TN 38104-7241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 31/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AG6742969 | DEA (01) | TN |
B02753 | (02) | TN |