Provider Demographics
NPI:1275657504
Name:GIBSON, VALERIE A (DO)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
Last Name:GIBSON
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 1:3729 W 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3121
Mailing Address - Country:US
Mailing Address - Phone:303-916-1064
Mailing Address - Fax:
Practice Address - Street 1:3729 W 32ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3121
Practice Address - Country:US
Practice Address - Phone:303-916-1064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9705207Q00000X
CO0050719207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACE972VMedicare UPIN
CACE942TMedicare UPIN
CACE942SMedicare UPIN
CACE942UMedicare UPIN
CACE942WMedicare UPIN
CACE942XMedicare UPIN
CACE942YMedicare UPIN