Provider Demographics
NPI:1215201439
Name:GIBSON, DARA TANIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DARA
Middle Name:TANIA
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 505262
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63150-5262
Mailing Address - Country:US
Mailing Address - Phone:620-688-6566
Mailing Address - Fax:620-688-6577
Practice Address - Street 1:1717 W 8TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337
Practice Address - Country:US
Practice Address - Phone:620-251-0777
Practice Address - Fax:620-251-4173
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-35593207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology