Provider Demographics
NPI:1740204478
Name:GIBSON, JOHN MCNEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MCNEIL
Last Name:GIBSON
Suffix:
Gender:M
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 601643
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1643
Mailing Address - Country:US
Mailing Address - Phone:704-302-8600
Mailing Address - Fax:704-302-8650
Practice Address - Street 1:16455 STATESVILLE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7135
Practice Address - Country:US
Practice Address - Phone:704-302-8600
Practice Address - Fax:704-302-8650
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC17964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN17964Medicaid
NC8935324Medicaid
NC206602NMedicare PIN
NC8935324Medicaid
NC206602MMedicare PIN
NCC84030Medicare UPIN
NC206602LMedicare PIN