Provider Demographics
NPI:1639372675
Name:GIBSON, AMEE (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMEE
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:AMEE
Other - Middle Name:
Other - Last Name:LEBRIJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:400 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:MN
Mailing Address - Zip Code:56267-1408
Mailing Address - Country:US
Mailing Address - Phone:320-589-1313
Mailing Address - Fax:320-589-3533
Practice Address - Street 1:400 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1408
Practice Address - Country:US
Practice Address - Phone:320-589-1313
Practice Address - Fax:320-589-3533
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN637213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU84396Medicare UPIN