Provider Demographics
NPI:1043554116
Name:GIBBS, STEVEN CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:GIBBS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 UPPERHILL RD
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-1426
Mailing Address - Country:US
Mailing Address - Phone:415-454-1460
Mailing Address - Fax:415-256-7312
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:CALIFORNIA STATE PRISON, MENTAL HEALTH DEPT.
Practice Address - City:SAN QUENTIN
Practice Address - State:CA
Practice Address - Zip Code:94964-1000
Practice Address - Country:US
Practice Address - Phone:415-454-1460
Practice Address - Fax:415-256-7312
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC295912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry