Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | NOT YET ISSUED | CA |
Y | 207VG0400X | Gynecologist | 47651 | AZ |
NPI | 1033348487 |
---|---|
Provider Name | Jill D Gibson |
First Address | Phoenix, AZ 85014-5699 |
Second Address | Phoenix, AZ 85014-5699 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 18/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
809194 | (05) | AZ |