Provider Demographics
NPI:1730300716
Name:GIBBONS, BETH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
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 1:1800 15TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4595
Mailing Address - Country:US
Mailing Address - Phone:970-350-5996
Mailing Address - Fax:
Practice Address - Street 1:1800 15TH ST STE 130
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4595
Practice Address - Country:US
Practice Address - Phone:970-350-5996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0600003285390200000X
CODR0052703207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO98472046Medicaid
FG3989324OtherDEA