Provider Demographics
NPI:1396408472
Name:GIBBS, JOHN FITZGERALD
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FITZGERALD
Last Name:GIBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 ZIRCON DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98498-3416
Mailing Address - Country:US
Mailing Address - Phone:253-380-6129
Mailing Address - Fax:
Practice Address - Street 1:9715 ZIRCON DR SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-3416
Practice Address - Country:US
Practice Address - Phone:253-380-6129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-15
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies