Provider Demographics
NPI:1689636268
Name:GIBBONS, OLGA (MD)
Entity Type:Individual
Prefix:DR
First Name:OLGA
Middle Name:
Last Name:GIBBONS
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 1:601 UNIVERSITY BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2788
Mailing Address - Country:US
Mailing Address - Phone:561-768-7886
Mailing Address - Fax:561-627-3991
Practice Address - Street 1:3385 BURNS RD STE 203
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4328
Practice Address - Country:US
Practice Address - Phone:561-768-7886
Practice Address - Fax:561-627-3991
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161590207Q00000X
FLME114917207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014685500-EFF 4/9/15Medicaid
FLDV3514-P01508770OtherRAILROAD MEDICARE-
NY00930176Medicaid
FL01468550Medicaid
NY60D241Medicaid
FLDV3514-P01508770OtherRAILROAD MEDICARE-