Provider Demographics
NPI:1164555058
Name:JEFFREY L GIBSON DO PC
Entity Type:Organization
Organization Name:JEFFREY L GIBSON DO PC
Other - Org Name:JEFF GIBSON DO
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-273-2761
Mailing Address - Street 1:307A S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-3622
Mailing Address - Country:US
Mailing Address - Phone:918-273-2761
Mailing Address - Fax:918-273-2753
Practice Address - Street 1:307A S LOCUST ST
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-3622
Practice Address - Country:US
Practice Address - Phone:918-273-2761
Practice Address - Fax:918-273-2753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3261207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty