Provider Demographics
NPI:1336146422
Name:GIBSON, STEVEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3554
Mailing Address - Country:US
Mailing Address - Phone:812-282-1888
Mailing Address - Fax:812-285-8892
Practice Address - Street 1:510 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3554
Practice Address - Country:US
Practice Address - Phone:812-282-1888
Practice Address - Fax:812-285-8892
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2015-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY364802084P0800X
IN010534852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000239196OtherANTHEM
IN160780OtherMEDICARE GROUP #
1063415297OtherPV GROUP NPI #
182992000OtherMAGELLAN MIS #
KY64034671Medicaid
KYCK2274OtherRAILROAD MEDICARE GROUP
KY82900176Medicaid
INCG3623OtherRAILROAD MEDICARE GROUP
IN100386460Medicaid
50704000OtherMAGELLAN MIS GROUP
KYP00708801OtherRAIL ROAD MEDICARE
IN200298400AMedicaid
IN260048976OtherMEDICARE RAILROAD
000000056294OtherANTHEM GROUP #
IN160860OtherMEDICARE GROUP #
KY2700874000OtherPASSPORT ADVANTAGE
KY65927857Medicaid
KY78903689Medicaid
KY2444451000OtherPASSPORT GROUP #
KY6764OtherMEDICARE GROUP #
IN160780OtherMEDICARE GROUP #
KY64034671Medicaid
KY65927857Medicaid