Provider Demographics
NPI:1437577913
Name:GIBBONEY, MICHAEL DAVID (DPM)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:GIBBONEY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL HOSPITAL OKINAWA
Mailing Address - Street 2:CAMP FOSTER
Mailing Address - City:FPO
Mailing Address - State:IL
Mailing Address - Zip Code:96363
Mailing Address - Country:US
Mailing Address - Phone:098-971-9355
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL OKINAWA
Practice Address - Street 2:CAMP FOSTER
Practice Address - City:FPO
Practice Address - State:IL
Practice Address - Zip Code:96362
Practice Address - Country:US
Practice Address - Phone:098-971-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006592213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery