Provider Demographics
NPI:1477634442
Name:GIBBS, LARRY M (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:M
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 830674
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0674
Mailing Address - Country:US
Mailing Address - Phone:205-313-5262
Mailing Address - Fax:205-313-5245
Practice Address - Street 1:995 9TH AVE SW
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-4527
Practice Address - Country:US
Practice Address - Phone:205-313-5262
Practice Address - Fax:205-313-5245
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12214207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-24755OtherBCBS
AL515-24755OtherBCBS
AL515-24755Medicare ID - Type Unspecified