Provider Demographics
NPI:1235425448
Name:GIBBS, MARY-LIBERTY Y (DO)
Entity Type:Individual
Prefix:DR
First Name:MARY-LIBERTY
Middle Name:Y
Last Name:GIBBS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10624 S EASTERN AVE
Mailing Address - Street 2:# A-955
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-2982
Mailing Address - Country:US
Mailing Address - Phone:702-407-7700
Mailing Address - Fax:702-407-7016
Practice Address - Street 1:6210 N DURANGO DR BLDG 11
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-3916
Practice Address - Country:US
Practice Address - Phone:702-940-1540
Practice Address - Fax:702-940-1541
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-26
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203392207R00000X
NVDO2536207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDO2536OtherSTATE LICENSE
NV1235425448Medicaid