Provider Demographics
NPI:1437498276
Name:GIBSON, DAVID JAMES (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
Last Name:GIBSON
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 1:4830 OAK VISTA DR
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6207
Mailing Address - Country:US
Mailing Address - Phone:916-359-4365
Mailing Address - Fax:916-359-4267
Practice Address - Street 1:4830 OAK VISTA DR
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6207
Practice Address - Country:US
Practice Address - Phone:916-359-4369
Practice Address - Fax:916-359-4267
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33504207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology