Provider Demographics
NPI:1215042700
Name:GIBBONS, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JAMES
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 YOUNGS RD STE 110
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2698
Mailing Address - Country:US
Mailing Address - Phone:716-961-9900
Mailing Address - Fax:716-961-9911
Practice Address - Street 1:1020 YOUNGS RD STE 110
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2698
Practice Address - Country:US
Practice Address - Phone:716-961-9900
Practice Address - Fax:716-961-9911
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163600207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005249731OtherHEALTH NOW
NY01781626Medicaid
NY2809907OtherINDEPENDENT HEALTH
NY00020506601OtherEXCELLUS UNIVERA
NY01781626Medicaid
NY005249731OtherHEALTH NOW
NYRB1769Medicare PIN