Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 0101030347 | VA |
NPI | 1023174737 |
---|---|
Provider Name | Robert S. Gibson |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 25/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006097120 | (05) | VA |
B06962 | (02) | VA |