Provider Demographics
NPI:1164712345
Name:GIBBONS, JOHN PATRICK
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43A AVONDALE COURT
Mailing Address - Street 2:
Mailing Address - City:BLACKROCK
Mailing Address - State:CO. DUBLIN
Mailing Address - Zip Code:000
Mailing Address - Country:IE
Mailing Address - Phone:00135386-891-5550
Mailing Address - Fax:
Practice Address - Street 1:43A AVONDALE COURT
Practice Address - Street 2:
Practice Address - City:BLACKROCK
Practice Address - State:CO. DUBLIN
Practice Address - Zip Code:000
Practice Address - Country:IE
Practice Address - Phone:00135386-891-5550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program