Provider Demographics
NPI:1609966266
Name:GIBBONS, TROY (MD)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 LEADER AVE OFC 208
Mailing Address - Street 2:DEPT. OF PEDIATRICS, DIVISION OF GASTROENTEROLOGY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40506-9983
Mailing Address - Country:US
Mailing Address - Phone:859-218-1676
Mailing Address - Fax:859-257-7799
Practice Address - Street 1:138 LEADER AVE OFC 208
Practice Address - Street 2:DEPT. OF PEDIATRICS, DIVISION OF GASTROENTEROLOGY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40506-9983
Practice Address - Country:US
Practice Address - Phone:859-218-1676
Practice Address - Fax:859-257-7799
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-31622080P0206X
KY485032080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146288001Medicaid
AR146288001Medicaid
5M107Medicare PIN