Provider Demographics
NPI:1225010986
Name:OLSON GIBBS, KIM RENEE (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:RENEE
Last Name:OLSON GIBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 E 2ND ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5600
Mailing Address - Country:US
Mailing Address - Phone:480-949-9047
Mailing Address - Fax:480-994-5586
Practice Address - Street 1:7301 E 2ND ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5600
Practice Address - Country:US
Practice Address - Phone:480-949-9047
Practice Address - Fax:480-994-5586
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31648207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ926230Medicaid
AZZ103237Medicare PIN
I29767Medicare UPIN