Provider Demographics
NPI:1689782468
Name:GIBSON, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8101 HINSON FARM RD
Mailing Address - Street 2:#118
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3403
Mailing Address - Country:US
Mailing Address - Phone:703-360-3008
Mailing Address - Fax:703-360-6204
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:#118
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3404
Practice Address - Country:US
Practice Address - Phone:703-360-3008
Practice Address - Fax:703-360-6204
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-06-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101030484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5680701Medicaid
C88730Medicare UPIN
VA5680701Medicaid