Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD.41041 | AL |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD.41041 | AL |
NPI | 1326571084 |
---|---|
Provider Name | Richard Dale Gibson |
First Address | Franklin, TN 37067-5791 |
Second Address | Franklin, TN 37067-5791 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2017 |
Last Update Date | 02/09/2021 |