Provider Demographics
NPI:1629129739
Name:GIBSON, RONALD EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:EUGENE
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-4038
Mailing Address - Country:US
Mailing Address - Phone:307-235-4185
Mailing Address - Fax:307-235-4127
Practice Address - Street 1:1705 E 12TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4038
Practice Address - Country:US
Practice Address - Phone:307-235-4185
Practice Address - Fax:307-235-4127
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3401A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW302164Medicare ID - Type Unspecified
WYA73004Medicare UPIN