Provider Demographics
NPI:1083609606
Name:GIBSON, WILLIAM LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LEONARD
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:BAPTIST HEALTH CENTER - SNEAD
Mailing Address - City:SNEAD
Mailing Address - State:AL
Mailing Address - Zip Code:35952-0576
Mailing Address - Country:US
Mailing Address - Phone:205-466-7114
Mailing Address - Fax:205-466-3350
Practice Address - Street 1:180 MEDICAL ST
Practice Address - Street 2:BAPTIST HEALTH CENTER - SNEAD
Practice Address - City:SNEAD
Practice Address - State:AL
Practice Address - Zip Code:35952
Practice Address - Country:US
Practice Address - Phone:205-466-7114
Practice Address - Fax:205-466-3350
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10779207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000085126Medicaid
AL051010596OtherBCBS
AL051545973OtherBCBS
AL051085126OtherBLUE CROSS
AL051554534Medicaid
AL051520363OtherBCBS
AL051554534Medicaid
ALD729Medicare PIN
AL510I930183Medicare PIN
AL051085126OtherBLUE CROSS
AL051010596OtherBCBS
ALF020Medicare PIN
AL051520363OtherBCBS
AL000085126Medicaid