Provider Demographics
NPI:1124574322
Name:GIBBS, CORA LEE (PA)
Entity Type:Individual
Prefix:MISS
First Name:CORA
Middle Name:LEE
Last Name:GIBBS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:SPORTS AND ORTHOPAEDIC SPECIALISTS
Mailing Address - Street 2:8100 W. 78TH STREET, SUITE 230
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2570
Mailing Address - Country:US
Mailing Address - Phone:952-946-9777
Mailing Address - Fax:
Practice Address - Street 1:SPORTS AND ORTHOPAEDIC SPECIALISTS
Practice Address - Street 2:8100 W 78TH STREET, SUITE 230
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2570
Practice Address - Country:US
Practice Address - Phone:952-946-9777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical