Provider Demographics
NPI:1154498525
Name:GIBSON, RONALD C (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 E CHICAGO ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2086
Mailing Address - Country:US
Mailing Address - Phone:517-278-7331
Mailing Address - Fax:517-278-9917
Practice Address - Street 1:360 E CHICAGO ST
Practice Address - Street 2:SUITE 110
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2086
Practice Address - Country:US
Practice Address - Phone:517-278-7331
Practice Address - Fax:517-278-9917
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIRG052179207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0120021Medicare ID - Type Unspecified
MIB43453Medicare UPIN