Provider Demographics
NPI:1235147653
Name:GIBBS, MARILYN ACHILLE (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:ACHILLE
Last Name: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 1:7440 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-7117
Mailing Address - Country:US
Mailing Address - Phone:253-475-0511
Mailing Address - Fax:
Practice Address - Street 1:7440 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7117
Practice Address - Country:US
Practice Address - Phone:253-475-0511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025090207PE0004X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGI0004OtherREGENCE BS PROV#
WA0185265OtherLABOR& IND PROV #
WA8133985Medicaid
WA8133985Medicaid
WA000108929Medicare ID - Type UnspecifiedMEDICARE PART B PROV#