Provider Demographics
NPI:1083717565
Name:GIBBS, JAMES E (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:GIBBS
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 1:2801 S RIDGEWOOD AVE UNIT 408
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-3505
Mailing Address - Country:US
Mailing Address - Phone:216-538-4729
Mailing Address - Fax:
Practice Address - Street 1:2450 MASON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5110
Practice Address - Country:US
Practice Address - Phone:386-676-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-02167207Q00000X
WV24750207Q00000X
OH35.043934207Q00000X
SC37406207Q00000X
VA0101256861207Q00000X
GA072607207Q00000X
TN51945207Q00000X
NH16754207Q00000X
KY47505207Q00000X
DCMD042677207Q00000X
ARE-10326207Q00000X
FLME108274207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1083717565OtherVHN
FL14S8ZOtherBCBS
FL1083717565OtherMULTIPLAN
FL009602100Medicaid
FL1083717565OtherTRICARE
FLP01574249OtherRAILROAD
FL009602100Medicaid