Madena Jane Gibson
General Practice Physician
1695 Moses Rd
Raymond
, Mississippi 39154-8766
Madena Jane Gibson
General Practice Physician
1695 Moses Rd
Raymond
, Mississippi 39154-8766
(601) 857-8638
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About
Features
Specialties
- General Practice Physician
Languages spoken
- English
Location
First Address
- Madena Jane Gibson
- 1695 Moses Rd
- Raymond, MS
- Zip : 39154-8766
- Phone : (601) 857-8638
Second Address
- Madena Jane Gibson
- 1695 Moses Rd
- Raymond, MS
- Zip : 39154-8766
- Phone : (601) 857-8638
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 208D00000X | General Practice Physician | 07981 | MS |
National Provider Identifier
| NPI | 1013431519 |
|---|---|
| Provider Name | Madena Jane Gibson |
| First Address | Raymond, MS 39154-8766 |
| Second Address | Raymond, MS 39154-8766 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 27/07/2017 |
| Last Update Date | 27/07/2017 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 07981 | MS MEDICAL LICENSURE (01) | MS |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.