Provider Demographics
NPI:1104838655
Name:GIBSON, JAMES ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ARTHUR
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5784 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-1876
Mailing Address - Country:US
Mailing Address - Phone:248-673-6667
Mailing Address - Fax:248-673-7234
Practice Address - Street 1:5784 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-1876
Practice Address - Country:US
Practice Address - Phone:248-673-6667
Practice Address - Fax:248-673-7234
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301065590207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG73046Medicare UPIN
MI0N83880Medicare PIN