Provider Demographics
NPI:1467410829
Name:GIBB, GREGORY N (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:N
Last Name:GIBB
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 1:2840 ONEIL LANE
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503
Mailing Address - Country:US
Mailing Address - Phone:707-443-9777
Mailing Address - Fax:707-445-1003
Practice Address - Street 1:2840 ONEIL LANE
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503
Practice Address - Country:US
Practice Address - Phone:707-443-9777
Practice Address - Fax:707-445-1003
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45184207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G451840Medicaid
CA00G451840Medicare ID - Type Unspecified
CA00G451840Medicaid