Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | A114646 | CA |
Y | 207RC0000X | Internist - Cardiovascular Disease | 8114646 | CA |
NPI | 1881920882 |
---|---|
Provider Name | Michael Austin Gibson |
First Address | Orange, CA 92868-3201 |
Second Address | Orange, CA 92868-3201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2009 |
Last Update Date | 17/03/2018 |