Provider Demographics
NPI:1417929373
Name:GIBBS, GORDON F (MD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:F
Last Name:GIBBS
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:PO BOX 7702
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-0702
Mailing Address - Country:US
Mailing Address - Phone:719-543-8346
Mailing Address - Fax:719-545-1829
Practice Address - Street 1:115 E RIVERWALK
Practice Address - Street 2:UNIT 200
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3308
Practice Address - Country:US
Practice Address - Phone:719-542-7891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO450042085R0202X, 2085R0204X
MN431532085R0202X
NE355242085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08179263Medicaid
MN852927200Medicaid
MN852927200Medicaid
COCO41318Medicare UPIN