Provider Demographics
NPI:1023003316
Name:GIPSON, WILLIAM T (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:GIPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 W CANAL CT
Mailing Address - Street 2:STE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5656
Mailing Address - Country:US
Mailing Address - Phone:303-791-7540
Mailing Address - Fax:303-791-2241
Practice Address - Street 1:1420 W CANAL CT
Practice Address - Street 2:STE 100
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5656
Practice Address - Country:US
Practice Address - Phone:303-791-7540
Practice Address - Fax:303-791-2241
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO25406207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01254069Medicaid
D24628Medicare UPIN
COC34431Medicare PIN