Provider Demographics
NPI:1376553610
Name:GIBBONS FAMILY MEDICINE
Entity Type:Organization
Organization Name:GIBBONS FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-469-1252
Mailing Address - Street 1:114 BRADY CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4554
Mailing Address - Country:US
Mailing Address - Phone:919-469-1252
Mailing Address - Fax:919-469-1373
Practice Address - Street 1:114 BRADY CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4554
Practice Address - Country:US
Practice Address - Phone:919-469-1252
Practice Address - Fax:919-469-1373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty