Provider Demographics
NPI:1326286568
Name:GIBSON, MELISSA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANNE
Last Name:GIBSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9560
Mailing Address - Fax:239-343-9624
Practice Address - Street 1:8925 COLONIAL CENTER DR STE 1000
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-7813
Practice Address - Country:US
Practice Address - Phone:239-343-9560
Practice Address - Fax:239-280-5998
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125135207QH0002X, 207QH0002X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105184500Medicaid