Provider Demographics
NPI:1386689636
Name:GIBSON, JOHN R (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 20TH AVE N
Mailing Address - Street 2:9TH FLOOR
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2131
Mailing Address - Country:US
Mailing Address - Phone:615-284-1400
Mailing Address - Fax:615-284-1349
Practice Address - Street 1:300 20TH AVE N
Practice Address - Street 2:9TH FLOOR
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2131
Practice Address - Country:US
Practice Address - Phone:615-284-1400
Practice Address - Fax:615-284-1349
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN13867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0050576OtherBLUE CROSS BLUE SHIELD
TN4082150OtherAETNA
TN3194593Medicaid
TN110054563OtherRR MEDICARE
TNB04611Medicare UPIN
TN3194593Medicaid