Provider Demographics
NPI:1275581449
Name:GIBBS, PAMALA J (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMALA
Middle Name:J
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 1:129 WHETSTONE ST
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36460-2625
Mailing Address - Country:US
Mailing Address - Phone:251-575-3939
Mailing Address - Fax:251-575-2379
Practice Address - Street 1:129 WHETSTONE ST
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36460-2625
Practice Address - Country:US
Practice Address - Phone:251-575-3939
Practice Address - Fax:251-575-2379
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21143207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALGI000016118Medicaid
AL051516118GIBMedicare ID - Type Unspecified
ALG80116Medicare UPIN