Provider Demographics
NPI:1346769627
Name:GIBSON, DAVID RANDOLPH (HEARING AID DISPENSE)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RANDOLPH
Last Name:GIBSON
Suffix:
Gender:M
Credentials:HEARING AID DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11899 EDGEWOOD RD STE B
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3435
Mailing Address - Country:US
Mailing Address - Phone:530-878-5158
Mailing Address - Fax:530-878-5159
Practice Address - Street 1:11899 EDGEWOOD RD STE B
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3435
Practice Address - Country:US
Practice Address - Phone:530-878-5158
Practice Address - Fax:530-878-5159
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist