Provider Demographics
NPI:1679503262
Name:GIBSON, STEPHANIE L (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:GIBSON
Suffix:
Gender:F
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:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0308
Mailing Address - Country:US
Mailing Address - Phone:316-283-2700
Mailing Address - Fax:
Practice Address - Street 1:600 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-8780
Practice Address - Country:US
Practice Address - Phone:316-283-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS28096207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100334990AMedicaid
KS11522OtherPHS
KS16991OtherCOVENTRY
KS100237OtherHPK
KS12149528OtherMULTIPLAN
KS054904OtherBCBS
KS111178050Medicare PIN
KS100237OtherHPK