Provider Demographics
NPI:1578565370
Name:GIBB, CLYDE E JR (MD)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:E
Last Name:GIBB
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E CARROLL ST
Mailing Address - Street 2:ATTN: PRMG
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:410-543-7531
Mailing Address - Fax:410-912-6386
Practice Address - Street 1:SNOW HILL FAMILY MEDICINE
Practice Address - Street 2:428 WEST MARKET STREET
Practice Address - City:SNOW HILL
Practice Address - State:MD
Practice Address - Zip Code:21863
Practice Address - Country:US
Practice Address - Phone:410-632-0892
Practice Address - Fax:410-632-2452
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-04-24
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Provider Licenses
StateLicense IDTaxonomies
MDD0063253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B06992Medicare UPIN