Provider Demographics
NPI:1497173595
Name:GIBSON, SAMANTHA GAIR (DPM)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:GAIR
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 HILTON RD STE C
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48220-1096
Mailing Address - Country:US
Mailing Address - Phone:248-965-2927
Mailing Address - Fax:248-965-2912
Practice Address - Street 1:3055 HILTON RD STE C
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:MI
Practice Address - Zip Code:48220-1096
Practice Address - Country:US
Practice Address - Phone:248-965-2927
Practice Address - Fax:248-965-2912
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002549213E00000X, 213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program