Provider Demographics
NPI:1588636260
Name:GIBSON, DEBRA M (DPM)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
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 1:1770 N ALSTON ST
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535-2274
Mailing Address - Country:US
Mailing Address - Phone:251-943-3668
Mailing Address - Fax:251-943-3314
Practice Address - Street 1:1770 N ALSTON ST
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535-2274
Practice Address - Country:US
Practice Address - Phone:251-943-3668
Practice Address - Fax:251-943-3314
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL244213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009964380Medicaid
2700024OtherUNITED
1922679OtherFIRST HEALTH
480032396OtherRAILROAD MEDICARE
4269840001OtherDMERC
AL51503119OtherBC/BS
7561257OtherAETNA
051503119Medicare ID - Type Unspecified
4269840001OtherDMERC