Provider Demographics
NPI:1508001074
Name:J SCOTT GIBSON MD PC
Entity Type:Organization
Organization Name:J SCOTT GIBSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:J SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-472-0888
Mailing Address - Street 1:851 NE BAKER ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-4991
Mailing Address - Country:US
Mailing Address - Phone:503-472-0888
Mailing Address - Fax:503-434-7246
Practice Address - Street 1:851 NE BAKER ST STE 3
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4991
Practice Address - Country:US
Practice Address - Phone:503-472-0888
Practice Address - Fax:503-434-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD14370207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty